BACKGROUND: Periampullary tumours (PAT) may cause obstruction of distal choledochus. The bile stasis is a risk factor for microbial colonisation of bile (bacteriobilia), cholangitis, hepatic insufficiency and coagulopathy. PAT obstruction can be managed surgically or non-operatively - by inserting a biliary drain or stent (BDS). Although BDS allows for adequate bile drainage, liver function restitution and coagulopathy, increased bacteriobilia has been reported and this is associated with an increased incidence of postoperative complications. METHODS: A monocentric, prospective, comparative study including 100 patients operated with PAT. The effects of bacteriobilia and the presence of a drain in the biliary tract on the development of postoperative complications were evaluated. RESULTS: Positive microbial findings in bile were found in 67% of patients. It was 98% in the biliary drain group vs. 36% in non-drained patients (p = 0.0001). In 68% 2 or more different bacterial strains were simultaneously present (p = 0.0001). Patients with a positive microbial finding in bile had more frequent incidence of infectious complications 40.2% (27) vs. 9.1% (3); p = 0.0011. The most frequent infectious complication was wound infection 29.8% (20) vs. 3.03% (1); p = 0.0014. Similarly, a higher incidence of postoperative infectious complications occurred in patients with BDS - 36% (18) vs. 24% (12); p = 0.2752. CONCLUSION: The presence of a drain or stent in the biliary tract significantly increases the microbial colonisation of bile. It is associated with a significant increase in infectious complications, especially infections in the wound.

• MeSH
• Cholangitis * epidemiology   etiology   surgery   MeSH
• Cholestasis * MeSH
• Humans MeSH
• Neoplasms * MeSH
• Postoperative Complications epidemiology   etiology   MeSH
• Prospective Studies MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

• MeSH
• Anti-Bacterial Agents administration & dosage   pharmacology   therapeutic use   MeSH
• Cholangiocarcinoma surgery   drug therapy   complications   MeSH
• Cholangitis etiology   drug therapy   MeSH
• Cholestasis * surgery   etiology   therapy   MeSH
• Drainage methods   nursing   MeSH
• Humans MeSH
• Neoplasms * complications   MeSH
• Jaundice, Obstructive diagnosis   etiology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

We present a case of a fish bone impacted in the papilla of Vater resulting in dyspepsia and mild elevation in liver function tests, which was subsequently treated endoscopically. Fish bones are one of the most commonly encountered swallowed foreign bodies. However, involvement of the biliary tract, such as the one described by us, represents an extremely rare complication of fish bone ingestion. The diagnosis of a foreign body in the biliary tract can be difficult, and early endoscopic or surgical extraction may be required to avoid complications such as biliary stone formation, obstructive jaundice, cholangitis or cholecystitis, and/or biliary sepsis. Prompt endoscopic treatment can avoid severe biliary complications or surgical therapy.

• MeSH
• Cholangiopancreatography, Endoscopic Retrograde MeSH
• Cholangitis * etiology   MeSH
• Meals MeSH
• Humans MeSH
• Gallstones * MeSH
• Biliary Tract * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Case Reports MeSH

BACKGROUND: Surgical factors and direct cytotoxicity of bile salts on cholangiocytes may play a role in the development of ischemic cholangiopathy (IC) after liver transplantation (LTx). There is no validated consensus on how to protect the bile ducts during procurement, static preservation, and LTx. Meanwhile, IC remains the most troublesome complication after LTx. AIM: To characterize bile duct management techniques during the LTx process among European transplant centers in cases of donation after brain death (DBD) and circulatory death (DCD). METHOD: An European Liver and Intestine Transplant Association-European Liver Transplant Registry web survey designed to conceal respondents' personal information was sent to surgeons procuring and/or transplanting livers in Europe. RESULTS: Sixty-five percent of responses came from large transplant centers (>50 procurements/y). In 8% of DBDs and 14% of DCDs the bile duct is not rinsed. In 46% of DBDs and 52% of DCDs surgeons prefer to remove the gallbladder after graft reperfusion. Protocols concerning preservation solutions (nature, pressure, volume) are extremely heterogeneous. In 54% of DBDs and 61% of DCDs an arterial back table pressure perfusion is performed. Steroids (20%-10%), heparin (72%-60%), prostacyclin (3%-7%), and fibrinolytics (4%-11%) are used as donor-protective interventions in DBD and DCD cases, respectively. In 2% of DBD and 6% of DCD cases a hepatic artery reperfusion is performed first. In 4% of DBD and 6% of DCD cases, fibrinolytics are administered through the hepatic artery during the bench and/or implantation. CONCLUSION: This European web survey shows for the first time the heterogeneity in the management of bile ducts during procurement, preservation, and transplantation in Europe. In the context of sharing more marginal liver grafts, an expert meeting must be organized to formulate guidelines to be applied to protect liver grafts against IC.

• MeSH
• Cholangitis etiology   MeSH
• Ischemia etiology   MeSH
• Humans MeSH
• Tissue and Organ Harvesting adverse effects   methods   MeSH
• Perfusion adverse effects   methods   MeSH
• Postoperative Complications etiology   MeSH
• Graft Survival MeSH
• Surveys and Questionnaires MeSH
• Reperfusion adverse effects   methods   MeSH
• Liver Transplantation adverse effects   MeSH
• Organ Preservation adverse effects   methods   MeSH
• Bile Ducts blood supply   transplantation   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Europe MeSH

• MeSH
• Alkaline Phosphatase genetics   isolation & purification   MeSH
• Liver Cirrhosis, Biliary diagnosis   etiology   therapy   MeSH
• Cholangitis * diagnosis   etiology   drug therapy   MeSH
• Cholestasis diagnosis   etiology   complications   MeSH
• Drug Therapy * methods   MeSH
• Disease Attributes MeSH
• Deoxycholic Acid analogs & derivatives   therapeutic use   MeSH
• Ursodeoxycholic Acid therapeutic use   MeSH
• Humans MeSH
• Mitochondrial Proteins antagonists & inhibitors   isolation & purification   MeSH
• Immune System Diseases epidemiology   genetics   complications   MeSH
• Liver Diseases diagnosis   etiology   complications   MeSH
• Pruritus drug therapy   complications   MeSH
• Risk Factors MeSH
• Statistics as Topic MeSH
• Liver Transplantation * MeSH
• Age Factors MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

• MeSH
• Hepatitis, Autoimmune * diagnosis   etiology   therapy   MeSH
• Azathioprine administration & dosage   adverse effects   therapeutic use   MeSH
• Liver Cirrhosis, Biliary diagnosis   etiology   therapy   MeSH
• Cholangitis * diagnosis   etiology   therapy   MeSH
• Cholestasis * diagnosis   etiology   therapy   MeSH
• Diagnostic Techniques, Digestive System classification   trends   MeSH
• Diagnostic Imaging methods   MeSH
• Diagnosis, Differential MeSH
• Drug Therapy methods   MeSH
• Disease Attributes MeSH
• Comorbidity MeSH
• Chenodeoxycholic Acid administration & dosage   adverse effects   therapeutic use   MeSH
• Ursodeoxycholic Acid administration & dosage   adverse effects   therapeutic use   MeSH
• Humans MeSH
• Prednisone administration & dosage   adverse effects   therapeutic use   MeSH
• Pruritus diagnosis   complications   therapy   MeSH
• Cholangitis, Sclerosing diagnosis   etiology   therapy   MeSH
• Statistics as Topic MeSH
• Liver Transplantation methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

• MeSH
• Cholangitis diagnostic imaging   etiology   surgery   MeSH
• Pancreatitis, Chronic diagnostic imaging   surgery   complications   MeSH
• Middle Aged MeSH
• Humans MeSH
• Pancreaticojejunostomy standards   MeSH
• Anastomosis, Roux-en-Y * standards   utilization   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

BACKGROUND AND STUDY AIMS: The aim of this study was to assess the significance and safety of endoscopic retrograde cholangiopancreatography (ERCP) in diagnosing and treating bile duct injuries in children. PATIENTS AND METHODS: Fourteen pediatric patients, with traumatic or postoperative bile duct injury, in which ERCP was performed, were retrospectively evaluated. RESULTS: We performed 46 ERCP and 12 endoscopic papillotomies in children with suspected bile duct injuries. A bile stent was primarily inserted in 13 patients and there were 20 replacements. Endoscopic treatment of bile leakage without need for bile duct sutures or reconstruction was successful in 85.7%. Post ERCP complications included cholangitis and recurrent bleeding, which occurred only in two patients each. CONCLUSIONS: ERCP and endoscopic bile stent insertion is a highly effective, minimally-invasive treatment for bile duct injury and should be included as part of the therapeutic procedures in pediatric patients with suspected bile duct injury.

• MeSH
• Cholangiopancreatography, Endoscopic Retrograde * MeSH
• Cholangitis etiology   MeSH
• Child MeSH
• Infant MeSH
• Humans MeSH
• Adolescent MeSH
• Bile Duct Diseases surgery   MeSH
• Postoperative Complications surgery   MeSH
• Postoperative Hemorrhage etiology   MeSH
• Child, Preschool MeSH
• Retrospective Studies MeSH
• Sphincterotomy, Endoscopic MeSH
• Stents MeSH
• Treatment Outcome MeSH
• Bile Ducts injuries   surgery   MeSH
• Check Tag
• Child MeSH
• Infant MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH

Juxtapapilární divertikl duodena je literárně uváděn jako možná příčina řady pankreatobiliárních onemocnění. Etiologická souvislost však často není považována za jednoznačnou a v reálné klinické praxi bývá možná role divertiklu podceňována, až popírána. Tento článek na základě kazuistiky a přehledu literatury na tuto problematiku poukazuje. Za klinicky významnou známku možného podílu divertiklu na potížích lze považovat vyplnění lumen divertiklu bezoárem. Tento nález by, po vyloučení jiných příčin, měl vést ke zvažování etiologické souvislosti divertiklu s pankreatobiliárními potížemi. Řešení představují endoskopická papilosfinkterotomie jako metoda první volby a chirurgický výkon (divertikulektomie, biliodigestivní spojka či kombinace) v případě recidiv potíží a selhání méně invazivního postupu.

Juxtapapillary duodenal diverticula are reported as a potential cause of many pancreatobiliary diseases. However, data concerning this association is inconsistent and the role of the diverticulum is often underestimated or even denied in clinical practice. This case report and literature review is aimed at pointing out this problem. Obstruction of the diverticulum with a food bezoar can be considered as an important clinical clue of the etiological role of the diverticulum in pancreatobiliary disease development. Endoscopic sphincterotomy is considered to be the treatment of the first choice, with surgery (diverticulectomy and/or biliodigestive anastomosis) reserved for cases where the minimally invasive approach fails.

• Keywords
• biliodigestivní spojka, periampulární divertikl,
• MeSH
• Ampulla of Vater surgery   MeSH
• Anastomosis, Surgical MeSH
• Surgical Procedures, Operative methods   MeSH
• Cholangiopancreatography, Endoscopic Retrograde MeSH
• Cholangitis etiology   MeSH
• Diverticulum * complications   MeSH
• Duodenum abnormalities   surgery   MeSH
• Middle Aged MeSH
• Humans MeSH
• Common Bile Duct Diseases * etiology   therapy   MeSH
• Duodenal Diseases * diagnosis   surgery   complications   MeSH
• Jaundice, Obstructive etiology   MeSH
• Pancreatitis etiology   MeSH
• Sphincterotomy, Endoscopic MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

Biliární papilomatóza představuje velmi raritní onemocnění charakterizované přítomností mnohočetných papilomů v intrahepatálních i extrahepatálních žlučových cestách, výjimečně postihující i vývod pankreatický. Symptomy zahrnují kolikovité bolesti břicha, dyspepsie a intermitentní obstrukční ikterus. I přesto, že byla popsána v dětském věku, postihuje zejména starší pacienty, muže 2× častěji než ženy. Kromě rizika maligního zvratu ohrožuje pacienty především obstrukcí žlučových či pankreatických cest a nasedající infekční komplikací. Diagnosticky se kromě endoskopické retrográdní cholangiopatikografie (ERCP) uplatňuje cholangioskopie s typickým makroskopickým nálezem a možností odebrat cílenou biopsii. Léčba je individualizovaná a zahrnuje hlavně chirurgické a drenážní výkony. Popis případu: Prezentujeme dva případy. První pacientka, žena (80 let), byla hospitalizována pro recidivující biliární koliky a obstrukční ikterus. Bylo provedeno ERCP se zavedením DB stentu pro stenózu na rozhraní choledochu a společného hepatiku, doplněno CT vyšetření břicha, endosonografické vyšetření a SpyGlass cholangioskopie s potvrzením diagnózy papilomatózy choledochu. Vzhledem k věku a celkovému stavu nebylo indikováno chirurgické řešení, pouze dlouhodobá perkutánní transhepatální drenáž (PTD). Pacientka zemřela v domácím prostředí dva měsíce od zavedení PTD a necelý rok od stanovení diagnózy. Druhá pacientka, asymptomatická žena, 59 let, byla došetřována pro USG nález dilatace extrahepatálních i intrahepatálních žlučových cest, elevaci GGT. Postupně podstoupila endosonografické vyšetření a ERCP s odběrem biopsie z distálního choledochu. Na základě histologie (papilární adenom) byla provedena SpyGlass cholangioskopie, která potvrdila mnohočetnou papilomatózu žlučových cest, pacientka radikální výkon odmítla, je nadále sledována v gastroenterologické ambulanci. Závěr: Papilomatóza žlučových cest patří mezi neobvyklé příčiny biliární obstrukce. Pro její diagnózu je klíčovým diagnostickým krokem provedení cholangioskopie s cíleným odběrem biopsie. V rámci diferenciální diagnostiky biliárních stenóz je nutné na toto onemocnění pomyslet a cholangioskopii u nemocných včas indikovat. Prognóza tohoto onemocnění s vysokým maligním potenciálem je závažná, jediná kurativní léčba je radikální chirurgický výkon. Zvyšující se dostupnost cholangioskopie zřejmě povede k četnější diagnostice tohoto onemocnění.

Biliary papillomatosis is a very rare disease, which is characterized by the presence of multiple papillomata involving the intrahepatic or extrahepatic biliary tract. Rarely it is also found in the pancreatic duct. Its symptoms include recurrent abdominal pain, dyspepsia and intermittent obstructive jaundice. Although it affects particularly older patients – men being affected twice as often as women – it has been also described in children. In addition to the risk of malignant reversal, the main risks for the patient include obstruction of the biliary or pancreatic duct and infectious complications. The diagnosis is based on a typical macroscopic appearance during cholangioscopy and microscopic evaluation of targeted samples. Treatment is individualized and includes mainly surgical procedures or drainage. Case study: We present two cases: An 80-year-old woman was hospitalized for recurrent biliary problems and obstructive jaundice. ERCP was performed with the introduction of the DB stent for stenosis between the common bile duct and common hepatic duct. The woman underwent a CT examination of the abdomen, endoscopic ultrasonography and cholangioscopy. The diagnosis of biliary papillomatosis was confirmed. Due to the patient’s age and overall condition, radical surgical treatment was contraindicated. Very soon, it was necessary to perform percutaneous transhepatic drainage. Two months after its introduction and one year after diagnosis, the woman died. The second patient, a 59-year-old woman was examined for asymptomatic dilatation of biliary duct on abdominal ultrasonography and elevated GGT level. She underwent endoscopic ultrasonography and ERCP with biopsy of the distal common bile duct. SpyGlass cholangioscopy was performed on the basis of histological examination (papillary adenoma) which revealed multiple papillomata of the common bile duct. She refused surgical treatment, and is now being observed in our gastroenterologic outpatient department. Conclusion: Biliary papillomatosis is among the unusual causes of biliary obstruction. Cholangiscopy with targeted sampling biopsy are the key methods of its diagnostic. This condition should always be considered in the context of differential diagnosis of benign biliary stenosis and cholangioscopy should be indicated soon. This condition with high malignant potential has a very poor prognosis; radical surgery is the only curative treatment. The increasing availability of cholangioscopy is likely to lead to a more frequent diagnosis of this disease. Key words: obstructive jaundice – cholangitis – abdominal pain – biliary tract neoplasms – cholestasis 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: 9. 5. 2015 Accepted: 16. 5. 2015

• MeSH
• Biopsy MeSH
• Abdomen ultrasonography   MeSH
• Digestive System Surgical Procedures MeSH
• Cholangiography methods   MeSH
• Cholangiopancreatography, Endoscopic Retrograde utilization   MeSH
• Cholangitis diagnosis   etiology   therapy   MeSH
• Cholecystolithiasis diagnosis   etiology   pathology   therapy   MeSH
• Cholestasis diagnosis   etiology   pathology   therapy   MeSH
• Dilatation, Pathologic diagnosis   etiology   complications   therapy   MeSH
• Child MeSH
• Adult MeSH
• Drainage methods   utilization   MeSH
• Common Bile Duct pathology   MeSH
• Fatal Outcome MeSH
• Middle Aged MeSH
• Humans MeSH
• Bile Duct Neoplasms diagnosis   complications   therapy   MeSH
• Bile Duct Diseases * diagnosis   etiology   pathology   therapy   MeSH
• Papilloma * diagnosis   complications   therapy   MeSH
• Tomography, X-Ray Computed MeSH
• Aged MeSH
• Stents MeSH
• Treatment Outcome MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Case Reports MeSH