Over a twenty-year period, we performed 255 ERCP procedures in infants aged up to 1 year. ERCP was indicated in cholestatic infants with suspicion of biliary obstruction. The most common diagnosis was biliary atresia (48%), choledochal cysts (13%), and choledocholithiasis (4%). The procedure complication rate was 13.7%. Hyperamylasemia occurred in 12.9%. More severe complications were rare-0.8% of ERCP procedure. There were no cases of postprocedural pancreatitis or death. Our study has proved that ERCP is a safe and reliable method in this age group. Its high specificity and negative predictive value for extrahepatic biliary atresia can prevent unnecessary surgeries in patients with normal bile ducts or endoscopically treatable pathologies.

• MeSH
• Cholangiopancreatography, Endoscopic Retrograde adverse effects   MeSH
• Choledocholithiasis * diagnostic imaging   surgery   MeSH
• Cholestasis * etiology   MeSH
• Hyperbilirubinemia MeSH
• Infant MeSH
• Humans MeSH
• Pancreatitis * MeSH
• Check Tag
• Infant MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH

Navzdory řadě studií je role a timing endoskopické retrográdní cholangiopankreatikografie (ERCP) v případě akutní biliární pankreatitidy (ABP) nadále předmětem diskuzí. Jasná indikace časné ERCP do 72 hodin je u pacientů s ABP v koincidenci s obstrukcí choledochu, v případě cholangitidy pak ERCP do 24 hodin. Kontroverzní je poté úloha ERCP u pacientů s ABP bez příznaků cholangitidy, resp. bez obstrukce žlučových cest konkrementem. Pokud je ERCP u ABP indikována, je její časnější provedení spojeno s nižším výskytem komplikací. Rozhodnutí o provedení ERCP se často opírá o nálezy z biochemického a transabdominálního ultrazvukového vyšetření. Výsledky těchto vyšetření mohou, ale nemusí, potvrdit přítomnost kamenů v choledochu. Účinnou a bezpečnou metodou dosahující senzitivity ERCP v diagnostice konkrementů v choledochu je endoskopická ultrasonografie (EUS) a magnetická rezonanční cholangiopankreatikografie (MRCP). Z důvodu prevence recidivy pankreatitidy a biliárních obtíží by měla být po zvládnutí ataky ABP provedena cholecystektomie.

Despite several studies, the role and timing of endoscopic retrograde cholangiopancreatography (ERCP) in the case of acute biliary pancreatitis (ABP) remains a subject of discussion.There is a clear indication of early ERCP within 72 hours in patients with ABP andcholedochal obstruction, moreover the ERCP within 24 hours in cases of cholangitis. However, the role of ERCP in patients with ABP without symptoms of cholangitis or concrements obstructing the bile duct is controversial. If ABP is indicated for the ERCP, the earlier the ERCP is performed the less complications it is associated with. The decision to perform ERCP is often based on findings from a biochemical and transabdominal ultrasound examination. The results of these examinations may, but may not, confirm the presence of stones in the choledochus. An effective and safe method approaching the sensitivity of ERCP in the diagnosis of concrements in the choledochus is endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP). The cholecystectomy should be performed to prevent a recurrence of pancreatitis and biliary problems after the successfully treatment of ABP.

• MeSH
• Early Diagnosis MeSH
• Cholangiopancreatography, Endoscopic Retrograde MeSH
• Cholangitis diagnosis   surgery   MeSH
• Cholecystectomy MeSH
• Choledocholithiasis MeSH
• Humans MeSH
• Biliary Tract Diseases * diagnosis   surgery   MeSH
• Pancreatitis * etiology   surgery   physiopathology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Overall MeSH

PURPOSE: To compare anthropometric data (body mass index [BMI]) in patients without lithiasis to patients with symptomatic simple cholelithiasis or choledocholithiasis. METHODS: We retrospectively reviewed data from 147 patients undergoing laparoscopic cholecystectomy between 2001-2015. Complete growth data from 98 patients was compared with anthropometric data from the population of the Czech Republic and a control group (BMI of 100 consecutive patients without biliary stones in abdominal ultrasound who were admitted to a surgical department for suspected appendicitis). RESULTS: The BMI of 75 children with simple cholelithiasis and 23 with choledocholithiasis was compared to the standard Czech pediatric population and to the control group. The median age (simple cholelithiasis and choledocholithiasis) was 16 years, and 35 patients (24%) had a family history of gallstones. Types of lithiasis included multiple (n = 120), solitary (n = 11), and sludge (n = 10). Five cases had polyps and one had gallbladder dysplasia. Patients with simple cholelithiasis had significantly higher BMI compared to the control group without cholelithiasis (p<0.0001) and the standard Czech population (p = 0.03). Patients with choledocholithiasis had a mean BMI significantly higher than that of the general population (p = 0.001) and the control group (p = 0.0001). Patients with choledocholithiasis had significantly higher BMI than those with simple cholelithiasis (p = 0.03). CONCLUSION: Patients with cholelithiasis had significantly higher BMI than the general population, and patients with choledocholithiasis had significantly higher BMI than patients with simple lithiasis. Elevated BMI is a risk factor for developing choledocholithiasis. ERCP and early laparoscopic cholecystectomy in patients with choledocholithiasis offer equivalent outcomes in patients with simple cholelithiasis.

• MeSH
• Cholangiopancreatography, Endoscopic Retrograde MeSH
• Cholecystectomy, Laparoscopic MeSH
• Choledocholithiasis etiology   pathology   surgery   MeSH
• Cholelithiasis etiology   pathology   surgery   MeSH
• Child MeSH
• Body Mass Index MeSH
• Infant MeSH
• Humans MeSH
• Adolescent MeSH
• Obesity complications   pathology   MeSH
• Child, Preschool MeSH
• Retrospective Studies MeSH
• Risk Factors MeSH
• Case-Control Studies MeSH
• Check Tag
• Child MeSH
• Infant MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic MeSH

• MeSH
• Barrett Esophagus surgery   MeSH
• Choledocholithiasis surgery   MeSH
• Cholestasis surgery   MeSH
• Natural Orifice Endoscopic Surgery * methods   MeSH
• Esophagoscopy methods   MeSH
• Endoscopy, Gastrointestinal * MeSH
• Congresses as Topic MeSH
• Humans MeSH
• Esophageal Diseases surgery   MeSH
• Randomized Controlled Trials as Topic MeSH
• Stents MeSH
• Check Tag
• Humans MeSH
• Publication type
• News MeSH

• MeSH
• Biliary Atresia diagnosis   MeSH
• Endoscopic Ultrasound-Guided Fine Needle Aspiration methods   instrumentation   MeSH
• Cholangiopancreatography, Endoscopic Retrograde methods   instrumentation   MeSH
• Choledocholithiasis diagnostic imaging   MeSH
• Cholestasis, Intrahepatic etiology   therapy   MeSH
• Humans MeSH
• Bile Duct Diseases * diagnostic imaging   MeSH
• Check Tag
• Humans MeSH

Diagnostika biliárnych stenóz a hlavne odlíšenie benígnej od malígnej lézie je v bežnej praxi stále zložité. Samotné cholangiografické nálezy pri ERCP alebo MRCP nie sú tak špecifické, aby jednoznačne určovali ďalší management pacientov. Hlavnú diagnostickú výzvu predstavujú indeterminované stenózy, u ktorých základný diagnostický postup vrátane abdominálnych zobrazovacích techník a ERCP s cytologickým sterom nevedie k jednoznačnej diagnóze. Perorálna cholangioskopia môže zlepšiť ich diagnostiku priamou vizualizáciou a umožňuje cielený odber biopsií so zámerom zvýšiť diagnostickú výťažnosť vyšetrenia. Možnosti cholangioskopie boli doteraz obmedzené a len niektoré pracoviská mali k dispozícii prvú generáciu cholangioskopie Spyglass? ktorá bola založená na fibrooptickom princípe. Kvalita obrazu nebola ideálna, odber biopsií či terapeutické zákroky boli so Spyglass? prvej generácie taktiež zložité. Nový systém pracujúci na princípe digitálneho zobrazenia (Spyglass™ DS) je charakterizovaný vyššou kvalitou obrazu oproti prvej generácii, taktiež odber biopsií sa zdá byť jednoduchší. V tomto článku sumarizujeme naše prvé skúsenosti s novým systémom Spyglass™ DS. Kľúčové slová: cholangioskopia SpyGlass™ DS – biliárna stenóza – endoskopická retrográdna cholangiopankreatografia

The diagnosis of biliary strictures remains challenging, and it can be difficult to differentiate between benign and malignant strictures. Cholangiography characteristics alone obtained during ERCP or MRCP may not be specific enough to indicate unambiguous decisions on patient management. Peroral choledochoscopy can improve the diagnosis of indeterminate strictures by visualisation of the mucosa at the stricture site and enables obtaining directed biopsies in order to increase the diagnostic yield. Cholangioscopy options have been limited so far. Some workplaces, including our department in Trnava, worked with the first generation cholangioscopy (SpyGlass?), which was based on the fibre-optic principle and image quality was not perfect. Therapeutic interventions and taking biopsy specimens was also difficult with the first generation SpyGlass?. The new system working on principle of a digital imaging (Spyglass™ DS) is characterized by improved image quality, which is incomparably better compared to the first generation, taking biopsies seems to be easier as well. The image quality is higher compared to the first generation and taking biopsies also seems to be easier. In this article we summarise our first experience with the new SpyGlass™ DS. Key words: cholangioscopy SpyGlass™ DS – biliary stenosis – endoscopic retrograde cholangiopancreatography The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers. Submitted: 17. 8. 2015 Accepted: 6. 10. 2015

• Keywords
• cholangioskopie SpyGlass™ DS, biliární stenóza,
• MeSH
• Biopsy MeSH
• Cholangiopancreatography, Endoscopic Retrograde MeSH
• Cholangitis diagnosis   MeSH
• Choledocholithiasis diagnosis   MeSH
• Cholestasis etiology   MeSH
• Endoscopy, Digestive System * methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Bile Duct Neoplasms diagnosis   MeSH
• Bile Duct Diseases * diagnosis   MeSH
• Aged MeSH
• Constriction, Pathologic * diagnosis   etiology   MeSH
• Bile Ducts pathology   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Case Reports MeSH

• Keywords
• MRCP - (magnetická rezonanční cholangiografie a pankreatografie), ERCP - (endoskopická retrográdní cholangiopankreatografie = cholangiopankreatikografie), CT a 3D CT cholangiografie, "Mother-baby" cholangioskopie, SpyGlass, Intraduktální sonografie, Přímá transpapilární cholangioskopie, Perkutánní transhepatální cholangioskopie,
• MeSH
• Choledocholithiasis therapy   MeSH
• Diagnostic Techniques, Digestive System * instrumentation   trends   utilization   MeSH
• Endosonography methods   trends   utilization   MeSH
• Humans MeSH
• Bile Duct Diseases * diagnosis   prevention & control   therapy   MeSH
• Tissue and Organ Harvesting methods   instrumentation   utilization   MeSH
• Statistics as Topic MeSH
• Constriction, Pathologic prevention & control   therapy   MeSH
• Ultrasonography * methods   trends   utilization   MeSH
• Check Tag
• Humans MeSH

• MeSH
• Barrett Esophagus therapy   therapy   MeSH
• Biopsy MeSH
• General Surgery MeSH
• Choledocholithiasis therapy   MeSH
• Diagnostic Techniques and Procedures * MeSH
• Photochemotherapy * methods   nursing   instrumentation   utilization   MeSH
• Gastroenterology * MeSH
• Gastrointestinal Hemorrhage therapy   MeSH
• Colorectal Neoplasms therapy   MeSH
• Microscopy, Confocal * methods   utilization   MeSH
• Laser Therapy * history   classification   methods   standards   instrumentation   utilization   MeSH
• Humans MeSH
• Esophageal Neoplasms therapy   MeSH
• Neoplasms MeSH
• Palliative Medicine MeSH
• Esophageal Stenosis pathology   prevention & control   therapy   MeSH
• Tissues MeSH
• Urology MeSH
• Check Tag
• Humans MeSH
• Publication type
• Newspaper Article MeSH

Prezentujeme případ kojence s elevací alkalické fosfatázy (ALP) narozeného ve 28. týdnu těhotenství. Z důvodu perzistující elevace ALP je ve věku tří měsíců kromě pravidelného denního podávání vitaminu D3, kalcia a fosfátu aplikován kalciferol intramuskulárně. Při následujícím vyšetření z důvodu neprospívání byla zjištěna elevace ALP, mírná hyperkalcemie, významná hyperkalcurie a zvýšená hladina 25-OH-vitaminu D. V dalším průběhu se objevily klinické i laboratorní známky cholestázy. Pomocí MRCP byla prokázaná obstrukce ve vývodných cestách žlučových v důsledku mnohočetné cholelitiázy. Vzhledem k perzistujícím klinickým i laboratorním známkám cholestázy bylo provedeno ERCP a zaveden stent do oblasti choledochu na specializovaném pracovišti. V průběhu dalšího sledování dochází k ústupu klinických problémů a vymizení laboratorních ukazatelů cholestázy. V další části sdělení je diskutována použitelnost hladin ALP jako izolovaného parametru pro monitorování rizika vývoje metabolického onemocnění kostí nedonošených (MOKN) a stejně tak i pro vedení léčby tohoto onemocnění. Současně je poukázána nutnost hodnocení elevace ALP v kontextu s ostatními laboratorními i klinickými nálezy.

We present a case of an infant born in the twenty-eighth week of pregnancy with elevated alkaline phosphatase (ALP). In addition to the regular daily supplementation of vitamin D, calcium and phosphate an intramuscular injection of cholecalciferol was administered in the age of three month because of persistent elevation of ALP. At the subsequent examination carried out because of failure to thrive mild hypercalcemia, significant hypercalciuria and raised level of 25-OH-vitamin D3 were detected. During the further follow-up clinical and laboratory signs of cholestasis appeared. The obstruction of the efferent bile ducts due to multiple cholelithiasis has been demonstrated by MRCP. Considering persistent clinical and laboratory signs of cholestasis ERCP was performed and a stent has been inserted into the bile duct at the specialized medical facility. During the subsequent follow-up regression of clinical problems and disappearance of laboratory markers of cholestasis occurred. In the subsequent discussion the utility of ALP as isolated parameter for the monitoring of the risk for metabolic bone disease of prematurity development as well as for the management of this disease is argued about. At the same time the necessity of evaluation of elevated ALP in the context of other laboratory and clinical findings is emphasized.

• Keywords
• metabolické onemocnění kostí nedonošených,
• MeSH
• Alkaline Phosphatase * blood   MeSH
• Cholangiopancreatography, Endoscopic Retrograde MeSH
• Cholecystectomy MeSH
• Cholecystolithiasis diagnosis   MeSH
• Choledocholithiasis diagnosis   MeSH
• Cholelithiasis diagnosis   MeSH
• Cholestasis * diagnosis   surgery   MeSH
• Phosphates administration & dosage   blood   metabolism   MeSH
• Hypercalcemia complications   blood   MeSH
• Hypercalciuria complications   MeSH
• Infant MeSH
• Humans MeSH
• Cholangiopancreatography, Magnetic Resonance MeSH
• Bone Diseases, Metabolic diagnosis   prevention & control   MeSH
• Common Bile Duct Diseases * diagnosis   MeSH
• Infant, Premature, Diseases MeSH
• Infant, Premature metabolism   MeSH
• Stents MeSH
• Calcium administration & dosage   blood   metabolism   MeSH
• Vitamin D * administration & dosage   adverse effects   MeSH
• Check Tag
• Infant MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

V našem sdělení popisujeme případ 68leté ženy, která byla odeslána k provedení ERCP pro sonografický nález dilatace žlučových cest s choledocholitiázou. Jednalo se o pacientku, která před mnoha lety podstoupila klasickou cholecystektomii komplikovanou netěsností pahýlu cystiku řešenou zavedením biliárního stentu. Pacientka v dalších letech nedocházela na ambulantní kontroly, a stent tak byl ponechán ve žlučových cestách přes deset let. Při ERCP došlo po extrakci starého stentu k náhlé kardio­respirační nestabilitě pacientky. Urychleně byl zaveden nový biliární stent. Na akutně provedeném CT vyšetření byl zjištěn rozsáhlý bilaterální pneumothorax jako důsledek post-ERCP perforace s průnikem vzduchu do retroperitonea.

We present the case of a 68-year-old female patient sent by her GP for an ERCP because of a sonographic finding of biliary dilation with choledocholithiasis. Our patient underwent open cholecystectomy in 2002, the operation was complicated by a leakage of d. cysticus resolved by ERCP with an installation of a biliary stent. The patient did not comply with ambulatory dispensarisation, therefore the stent was left in the biliary tract for more than ten years. Extraction of the stent during ERCP immediately led to cardiorespiratory distress in the patient. A new biliary stent was introduced without delay. An urgent CT scan revealed a massive bilateral pneumothorax as a result of post-ERCP perforation. Key words: ERCP – complication – perforation – pneumomediastinum – pneumothorax The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers. Submitted: 3. 2. 2014 Accepted: 18. 5. 2014

• MeSH
• Cholangiopancreatography, Endoscopic Retrograde * adverse effects   MeSH
• Choledocholithiasis MeSH
• Dilatation, Pathologic MeSH
• Emphysema diagnosis   etiology   therapy   MeSH
• Humans MeSH
• Mediastinal Emphysema diagnosis   etiology   therapy   MeSH
• Common Bile Duct Diseases MeSH
• Pneumothorax diagnosis   etiology   therapy   MeSH
• Tomography, X-Ray Computed MeSH
• Aged MeSH
• Stents * MeSH
• Bile Ducts, Intrahepatic MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Case Reports MeSH