Comparison of Biliary Stent versus Biliary Sphincterotomy Alone in the Treatment of Bile Leak.

Background And Aims: Bile leaks are uncommon but are a painful postoperative complication of hepatobiliary interventions. Many authors advocate treating them with biliary stenting. We compared the outcomes in patients treated with endoscopic biliary sphincterotomy (EBS) alone versus EBS with biliary stenting.

Bilateral unilateral placement of metal stents for inoperable high-grade hilar biliary strictures: A systemic review and meta-analysis.

Background: Bilateral unilateral biliary stenting is used for palliation in malignant biliary obstruction. No clear data is available to compare the efficacy and safety of bilateral biliary stenting over unilateral stenting.

Aim: To assess the efficacy and safety of bilateral unilateral biliary drainage in inoperable malignant hilar obstruction.

Endoscopic Retrograde Cholangio-Pancreatography-Obtained Bile Culture Can Guide Antibiotic Therapy in Acute Cholangitis.

Background: Only a small proportion of patients with biliary tree infection grow microorganisms in blood cultures. Antibiotics chosen or tailored based on organisms identified on blood cultures have a potential for under-treatment and unfavorable outcomes, including recurrent infection and early stent occlusion. In our current practice, we collect bile for culture if an Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is performed in patients with suspected cholangitis.

Serous Cystadenocarcinoma of the Pancreas: Clinical Features and Management of a Rare Tumor.

Background/aims: The vast majority of serous cystic neoplasms of the pancreas are benign, and small, asymptomatic lesions, which are generally managed with observation. However, some of these tumors may attain a large size and occasionally metastasize.

Methods: In this study, we present a 78-year-old man with serous cystadenocarcinoma of the pancreas with liver metastases treated by distal pancreatectomy and liver ablation, who went on to develop new liver metastases 5 years after the initial operation.

Complications and survival associated with operative procedures in patients with unresectable pancreatic head adenocarcinoma.

Background: Unresectable tumors of the pancreatic head are encountered in up to 20% of patients taken for resection. The objective of this study was to evaluate the complications and outcome associated with palliative surgical procedures to help guide management decisions in these patients.

Methods: Patients with pancreatic head adenocarcinoma taken to the operating room with curative intent who did not undergo pancreatectomy were evaluated.

[Long-term, tumor-free survival after radiotherapy combining hepatectomy-Whipple en bloc and orthotopic liver transplantation for early-stage hilar cholangiocarcinoma].

Objective: To report the experience in surveillance and early detection of cholangiocarcinoma (CC) and in using en bloc total hepatectomy-pancreaticoduodenectomy-orthotopic liver transplantation (OLT-Whipple) to achieve complete eradication of early-stage CC complicating primary sclerosing cholangitis (PSC).

Methods: Asymptomatic PSC patients underwent surveillance using endoscopic ultrasound and endoscopic retrograde cholangiopancreatography (ERCP) with multilevel brushings for cytological evaluation. Patients diagnosed with CC were treated with combined extra-beam radiotherapy, lesion-focused brachytherapy, and OLT-Whipple.

Long-term, tumor-free survival after radiotherapy combining hepatectomy-Whipple en bloc and orthotopic liver transplantation for early-stage hilar cholangiocarcinoma.

This retrospective study reviews our experience in surveillance and early detection of cholangiocarcinoma (CC) and in using en bloc total hepatectomy-pancreaticoduodenectomy-orthotopic liver transplantation (OLT-Whipple) to achieve complete eradication of early-stage CC complicating primary sclerosing cholangitis (PSC). Asymptomatic PSC patients underwent surveillance using endoscopic ultrasound and endoscopic retrograde cholangiopancreatography (ERCP) with multilevel brushings for cytological evaluation. Patients diagnosed with CC were treated with combined extra-beam radiotherapy, lesion-focused brachytherapy, and OLT-Whipple.

Hyperbaric oxygen treatment of hemorrhagic radiation-induced gastritis after esophagectomy.

My colleagues and I present 2 cases of hemorrhagic postesophagectomy gastritis after chemoradiotherapy for esophageal cancer. On the basis of the location of the gastritis (lesser curve and midstomach) and the classic radiation injury appearance, radiation damage was believed to be the cause. In both patients, hyperbaric oxygen therapy rapidly arrested bleeding.

Dietary fructose intolerance: diet modification can impact self-rated health and symptom control.

Carbohydrate intolerance to lactose is widely accepted as a cause of gastrointestinal symptoms, but controversy persists on how important dietary fructose intolerance (DFI) is in causing gastrointestinal pain and suffering and if an elimination diet can control the presenting complaints. The objective of this study was to identify a group of well-defined DFI patients and explore whether dietary education followed by dietary compliance could control symptoms and improve quality of life. During a 5-year period, patients referred to a pancreato-biliary clinic were evaluated for dietary carbohydrate intolerances if they presented with gastrointestinal pain and/or gas and/or bloating and/or diarrhea.

Phantom study to determine radiation exposure to medical personnel involved in ERCP fluoroscopy and its reduction through equipment and behavior modifications.

Objective: The aim of this work is to evaluate the potential radiation exposure to medical personnel by comparing results from phantom studies of two different fluoroscopic units used for ERCP, and to determine which equipment or behavior modification can reduce radiation exposure.

Methods: Radiation exposures using an opaque tissue equivalent chest phantom with an abdominal insert were performed on a stationary dedicated fluoroscopy unit and a mobile C-arm unit, comparing varying equipment manipulations. Scatter radiation was recorded at 1) the patients' head, 2) where the endoscopist stands, and 3) where the equipment personnel stands.