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Hepatobiliary scintigraphy in the distinction between biliary hypoplasia and biliary atresia  [cached]
El-Desouki Mahmoud,Mohamadiyah Mohammed,Al Rabeeah Abdullah,Othman Saleh
Saudi Journal of Gastroenterology , 1998,
Abstract: The aim of this work is to see whether distinction between biliary atresia and biliary hypoplasia is possible or not and to present the value and usefulness of hepatobiliary scintigraphy in the investigation of infants with persistent hyperbilirubinemia. Seventy-seven patients of the age between five days and six months (average 62 days), 43 females and 34 males of which 65 Saudi, and 12 non-Saudis were investigated. Laboratory tests, abdominal ultrasound, hepatobiliary scintigraphy, liver biopsy, explorative laparatomy and intraoperative cholangiography were performed whenever indicated. The findings on hepatobiliary scintigraphy of nonvisualization of the gallbladder and no activity in the bowel upto 24 hours post injection were considered consistent with the diagnosis of biliary atresia. Minimal bowel activity, or visualization of the gallbladder where consistent with biliary hypoplasia. In addition, the liver in the two entities appeared in a different shape and can be used as an additional distinctive feature. Thirty-four infants were diagnosed by hepatobiliary scintigraphy as having biliary atresia. Only 3 of the 34 were false positives as compared to cholangiogram and liver biopsy results. Five cases were biliary hypoplasia. Hepatobiliary scintigraphy in infants with persistent hyperbilirubinemia can be distinguished between BA and BH in a simple and noninvasive approach.
Application of ursodeoxycolic acid in hepatobiliary scintigraphy for neonatal hyperbilirubinemia: comparison with phenobarbital
Enayatollah Nemat Khorasani
Iranian Journal of Nuclear Medicine , 2010,
Abstract: Introduction: Early differentiation of biliary atresia from neonatal hepatitis is of utmost importance, since on time surgery of biliary atresia significantly 7 h ad neonatal hepatitis. The specificity improves the outcome. Hepatobiliary scintigraphy is an integral part of diagnosis work-up of these patients; however its specificity for diagnosis of biliary atresia is suboptimal. In this study we evaluated the value of ursodeoxycholic acid pre-treatment for improvement of hepatobiliary scintigraphy specificity. Methods: 30 consecutive infants with direct heperbilirubinemia were included into the study. All infants underwent hepatobiliary scintigraphy with 99mTc-BrIDA twice (first after pre-treatment with Phenobarbital and the other time after pre-treatment with ursodeoxycholic acid. Results: Of 30 patients included into our study 13 had final diagnosis of extrahepatic biliary atresia and 1of hepatobiliary scintigraphy for diagnosis of biliary atresia was 80 % and 96.6 % for diagnosis of biliary atresia with phenobarbital and ursodeoxycholic acid respectively. All patients had complications of Phenobarbital administration (lethargy, poor feeding, irritability, hypotonia, etc) to some extent. These findings decreased significantly after discontinuation of Phenobarbital and were not present with ursodeoxycholic acid. Conclusion: Ursodeoxycholic acid is a safe and efficient drug for pre-treatment of patients with neonatal cholestasis syndrome who are going to undergo hepatobiliary scintigraphy. Compared to Phenobarbital, this drug has fewer complications and is more efficient. Keywords: Ursodeoxycholic acid, Hepatobiliary scintigraphy, Tc-99m BrIDA, Infantile jaundice, Neonatal Hyperbilirubinemia.
Endoscopic management of biliary strictures after liver transplantation  [cached]
Emmanuelle D Williams, Peter V Draganov
World Journal of Gastroenterology , 2009,
Abstract: Bile duct strictures remain a major source of morbidity after orthotopic liver transplantation (OLT). Biliary strictures are classified as anastomotic or non-anastomotic strictures according to location and are defined by distinct clinical behaviors. Anastomotic strictures are localized and short. The outcome of endoscopic treatment for anastomotic strictures is excellent. Non-anastomotic strictures often result from ischemic and immunological events, occur earlier and are usually multiple and longer. They are characterized by a far less favorable response to endoscopic management, higher recurrence rates, graft loss and need for retransplantation. Living donor OLT patients present a unique set of challenges arising from technical factors, and stricture risk for both recipients and donors. Endoscopic treatment of living donor OLT patients is less promising. Current endoscopic strategies for biliary strictures after OLT include repeated balloon dilations and placement of multiple side-by-side plastic stents. Lifelong surveillance is required in all types of strictures. Despite improvements in incidence and long term outcomes with endoscopic management, and a reduced need for surgical treatment, the impact of strictures on patients after OLT is significant. Future considerations include new endoscopic technologies and improved stents, which could potentially allow for a decreased number of interventions, increased intervals before retreatment, and decreased reliance on percutaneous and surgical modalities. This review focuses on the role of endoscopy in biliary strictures, one of the most common biliary complications after OLT.
Application of Ursodeoxycholic Acid in Hepatobiliary Scintigraphy for Neonatal Hyperbilirubinemia: Comparison with Phenobarbital
Enayatollah Nemat Khorasani,Fariba Mansouri
Iranian Journal of Nuclear Medicine , 2009,
Abstract: Introduction: Early differentiation of biliary atresia from neonatal hepatitis is of utmost importance, since on time surgery of biliary atresia significantly improves the outcome. Hepatobiliary scintigraphy is an integral part of diagnosis work-up of these patients; however its specificity for diagnosis of biliary atresia is suboptimal. In this study we evaluated the value of ursodeoxycholic acid pre-treatment for improvement of hepatobiliary scintigraphy specificity. Methods: Thirty consecutive infants with direct heperbilirubinemia were included into the study. All infants underwent hepatobiliary scintigraphy with 99mTc-bromo iminodiacetic acid (99mTc-BRIDA) twice (first after pre-treatment with phenobarbital and the other time after pre-treatment with ursodeoxycholic acid). Results: Of 30 patients included into our study 13 had final diagnosis of extrahepatic biliary atresia and 17 had neonatal hepatitis. Bowel was visualized in 11 patients with neonatal hepatitis after phenobarbital pre-treatment and in 16 after ursodeoxycholic acid pretreatment which amounts to 80 % and 96.6 % specificity for diagnosis of biliary atresia with phenobarbital and ursodeoxycholic acid respectively. All patients had complications of phenobarbital administration (lethargy, poor feeding, irritability, hypotonia, etc) to some extent. These findings decreased significantly after discontinuation of phenobarbital and were not present with ursodeoxycholic acid. Conclusion: Ursodeoxycholic acid is a safe and efficient drug for pre-treatment of patients with neonatal cholestasis syndrome who are going to undergo hepatobiliary scintigraphy. Compared to phenobarbital, this drug has fewer complications and is more efficient.
Update of cholangioscopy and biliary strictures  [cached]
Marcus W Chin,Michael F Byrne
World Journal of Gastroenterology , 2011, DOI: 10.3748/wjg.v17.i34.3864
Abstract: Cholangioscopy remains another modality in the investigation of biliary strictures. At cholangioscopy, the “tumour vessel” sign is considered a specific sign for malignancy. Through its ability to not only visualise mucosa, but to take targeted biopsies, it has a greater accuracy, sensitivity and specificity for malignant strictures than endoscopic retrograde cholangiopancreatography guided cytopathological acquisition. Cholangioscopy however, is time consuming and costly, requires greater technical expertise, and should be reserved for the investigation of undifferentiated strictures after standard investigations have failed.
ROLE OF HEPATOBILIARY SCINTIGRAPHY IN BILE LEAK DIANGNOSIS
M. SAGHARI,AMIRI.
Iranian Journal of Nuclear Medicine , 1994,
Abstract: Hepatobiliary scintigraphy is a sensitive method for intra & extera hepatic bile leak diagnosis. Bile lead may be seen after hepatobiliary surgery, trauma, inflammatory disease or malignant neoplasms. Although sonography and CT scanning are useful for diagnosis of peritoneal or perihepatic fluid, they cannot prove bile ascites. Hepatobiliary scintigraphy with Tc-99m-IDA agents is a physiologic and noninvasive test to confirm bile leak.
Variations in normal hepatobiliary scintigraphy in Indian population.  [cached]
Bhatt C,Kamdar N,Tilve G
Journal of Postgraduate Medicine , 1989,
Abstract: Hepatobiliary scintigraphy was performed with Tc99m iminodiacetic acid (IDA) analog, in 100 apparently healthy adults, to study the variations in the normal hepatobiliary scintigraphy. Gall bladder (GB) was visualised in 43% at 15 min; 87% at 30 min, 90% at 45 min and 99% at 60 min and the small intestine (SI) was visualised in 24% at 15 min, 69% at 30 min, 76% at 45 min and 92% at 60 min. Left hepatic duct was prominent in 45%. Reciprocal relation between SI and GB was observed in 21%.
Hepatobiliary scintigraphy in the diagnosis of choledochal cysts in children  [cached]
El Desouki Mahmoud,Mohamadiyeh Mohamad,Al Rabeaah Abdullah,Othman Saleh
Saudi Journal of Gastroenterology , 1997,
Abstract: The objective is to present the usefulness of hepatobiliary scintigraphy in the investigation of children with suspected choledochal cysts through our experience in King Khalid University Hospital at King Saud University, Riyadh. Seven patients aged between I and 10 years (average 4.8 yrs) comprising six females and one male were investigated. Laboratory tests, abdominal Ultrasound and/or CT, and cholangiography were performed whenever indicated. Persistent activity in a dilated common bile duct, with or without dilatation of intrahepatic bile ducts, was considered a positive indicator for choledochal cyst disease. Four children with cystic dilatation (type I) were diagnosed by hepatobiliary scintigraphy, one saccular (type II), and two cases of Caroli′s disease (type V). The diagnosis of choledochal cyst was proven by surgery with histological confirmation. Visualization of the gallbladder occurred in one case only. The common bile duct was seen in four cases. Late activity in the bowel was noted in two cases.
Current endoscopic approach to indeterminate biliary strictures  [cached]
David W Victor,Stuart Sherman,Tarkan Karakan,Mouen A Khashab
World Journal of Gastroenterology , 2012, DOI: 10.3748/wjg.v18.i43.6197
Abstract: Biliary strictures are considered indeterminate when basic work-up, including transabdominal imaging and endoscopic retrograde cholangiopancreatography with routine cytologic brushing, are non-diagnostic. Indeterminate biliary strictures can easily be mischaracterized which may dramatically affect patient’s outcome. Early and accurate diagnosis of malignancy impacts not only a patient’s candidacy for surgery, but also potential timely targeted chemotherapies. A significant portion of patients with indeterminate biliary strictures have benign disease and accurate diagnosis is, thus, paramount to avoid unnecessary surgery. Current sampling strategies have suboptimal accuracy for the diagnosis of malignancy. Emerging data on other diagnostic modalities, such as ancillary cytology techniques, single operator cholangioscopy, and endoscopic ultrasonography-guided fine needle aspiration, revealed promising results with much improved sensitivity.
Plastic or metal stents for benign extrahepatic biliary strictures: a systematic review
Petra GA van Boeckel, Frank P Vleggaar, Peter D Siersema
BMC Gastroenterology , 2009, DOI: 10.1186/1471-230x-9-96
Abstract: A systematic review on stent placement for benign extrahepatic biliary strictures was performed after searching PubMed and EMBASE databases. Data were pooled and evaluated for technical success, clinical success and complications.In total, 47 studies (1116 patients) on outcome of stent placement were identified. No randomized controlled trials (RCTs), one non-randomized comparative studies and 46 case series were found. Technical success was 98,9% for uncovered self-expandable metal stents (uSEMS), 94,8% for single plastic stents and 94,0% for multiple plastic stents. Overall clinical success rate was highest for placement of multiple plastic stents (94,3%) followed by uSEMS (79,5%) and single plastic stents (59.6%). Complications occurred more frequently with uSEMS (39.5%) compared with single plastic stents (36.0%) and multiple plastic stents (20,3%).Based on clinical success and risk of complications, placement of multiple plastic stents is currently the best choice. The evolving role of cSEMS placement as a more patient friendly and cost effective treatment for benign biliary strictures needs further elucidation. There is a need for RCTs comparing different stent types for this indication.Benign biliary strictures occur most frequently as a consequence of a surgical procedure of the gallbladder, mainly cholecystectomy, or common bile duct (CBD) [1]. Other causes include inflammatory conditions, such as chronic pancreatitis and sclerosing cholangitis [2]. In addition, cholelithiasis, sphincterotomy and infections of the biliary tract may also lead to a stricture [3]. Benign strictures of the biliary tract are associated with a broad spectrum of signs and symptoms, ranging from subclinical disease with mild elevation of liver enzymes to complete obstruction with jaundice, pruritus and cholangitis, and ultimately biliary cirrhosis [4].A bilio-digestive anastomosis, or a percutaneously or endoscopically performed dilation with or without stent placement are the most
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