Biliary decompression by nasobiliary catheter or biliary stent in acute suppurative cholangitis: A prospective randomized trial

Lee, Danny W.H.; Chan, Annie On On; Lam, Y. H.; Ng, Enders K.W.; Lau, James Y.; Law, Bonita Ka Bo; Lai, Chi Wai; Sung, Joseph J.Y.; Chung, S. C. S.

doi:10.1067/mge.2002.126886

Cited by 40 publications

(64 citation statements)

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“…The clinical response after successful insertion of 7 Fr or 10 Fr stent was comparable in the two groups. The success rate of biliary drainage in the present study was comparable to that found in other studies [7,12,13,18,21]. Approximately 20% of patients with acute cholangitis do not respond to antibiotics.…”

Section: Discussionsupporting

confidence: 89%

“…Other drawbacks are the need to reroute the NBD through the nasopharynx, patient discomfort and cosmetic problems related to its exit at the nostril and its winding around the face, and the need for the patient to carry a collecting bag with them wherever they go. Biliary stent placement has been found to be safe, easy to perform, and a good alternative to NBD placement for decompressing the biliary ductal system in patients with acute cholangitis [20][21][22]. There have been no reports comparing efficacy of 7 Fr and 10 Fr stent placement for biliary drainage in patients with acute cholangitis.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Biliary Drainage by 7 Fr or 10 Fr Stent Placement in Patients with Acute Cholangitis

et al. 2008

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Endoscopic Biliary Drainage by 7 Fr or 10 Fr Stent Placement in Patients with Acute Cholangitis

et al. 2008

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“…No significant difference in efficacy has been shown between stents and nasobiliary drains. However, patient discomfort appears to be higher with nasobiliary drains [38,39]. Biliary drainage can be successfully achieved by stent placement alone without sphincterotomy [40]; biliary sphincterotomy is associated with increased risk of complications, including bleeding, pancreatitis, and perforation.…”

Section: Biliary Drainagementioning

confidence: 99%

Diagnosis and Management of Acute Cholangitis

Mosler

2011

Curr Gastroenterol Rep

113

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Acute cholangitis is a potentially life-threatening systemic disease resulting from a combination of infection and obstruction of the biliary tree, secondary to different underlying etiologies. Common causes of cholangitis (eg, gallstones, benign and malignant biliary strictures) are well known. However, others (eg, immunoglobulin-G subclass-4-related sclerosing cholangitis) have been described only recently, are still under evaluation, and need to gain broader attention from clinicians. The diagnosis of acute cholangitis is based on clinical presentation and laboratory data indicating systemic infection, as well as diagnostic imaging modalities revealing signs of biliary obstruction and possibly an underlying etiology. The clinical presentation varies, and initial risk stratification is important to guide further management. Early medical therapy, including fluid resuscitation and appropriate antibiotic coverage, is of major importance in all cases, followed by a biliary drainage procedure and, if possible, definitive therapy of the underlying etiology. The type and timing of biliary drainage should be based on the severity of the clinical presentation, and the availability and feasibility of drainage techniques, such as endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC), and open surgical drainage. ERCP plays a central role in the management of biliary obstruction in patients with acute cholangitis. Endoscopic ultrasound-guided biliary drainage recently emerged as a possible alternative to PTC for second-line therapy if ERCP fails or is not possible.

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“…Les modalités techniques de ce drainage n'influence pas la survie des patients. Une étude randomisée prospective a comparé le drainage biliaire par drain nasobiliaire versus endoprothèse biliaire en cas d'angiocholite aiguë sévère d'origine lithiasique [18] : les auteurs concluaient à une efficacité identique pour les deux techniques en termes de succès et durée de procédure, de complications liées au geste et de mortalité.…”

Section: Aspects Techniquesunclassified

Quelles sont les vraies indications de la cholangiopancréatographie rétrograde endoscopique (CPRE) en urgence ?

Barange

2012

Acta Endosc

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La cholangiopancréatographie rétrograde endoscopique (CPRE) en urgence représente moins de 2 % de l'activité biliopancréatique d'une unité d'endoscopie. La CPRE en urgence doit être réalisée dans un délai de 12 heures suivant l'apparition des signes cliniques, ce qui conduit souvent à sa mise en oeuvre en dehors des heures ouvrables de fonctionnement de l'unité d'endoscopie. Elles requièrent l'utilisation de vidéoendoscopes et un équipement familier à l'opérateur. Ces gestes doivent être confiés à un endoscopiste expérimenté. La situation d'urgence n'exonère pas l'application des règles strictes de désinfection du matériel endoscopique. Les principales indications sont représentées par l'angiocholite aiguë avec sepsis et la pancréatite aiguë sévère le plus souvent d'origine lithiasique. Malgré les conditions difficiles inhérentes à l'état clinique du malade, le succès technique de la CPRE est voisin de 100 % et le risque de complications liées au geste est faible. Toutefois et du fait du contexte, la mortalité des malades peut atteindre 55 % principalement par défaillance multiviscérale. Pour citer cette revue : Acta Endosc. 42 (2012). Mots clés : Cathétérisme bilio-pancréatique · Endoscopie en urgence · Pancréatite aiguë · AngiocholiteAbstract Among all ERCPs performed in an endoscopy unit, emergencies account for less than 2 %. ERCP in emergency must be done within 12 hours after the beginning of clinical symptoms. Thus ERCP can have to be performed outside of the dedicated endoscopy unit. Video-endoscopes must then be preferred. Procedures must be performed by an experimented endoscopist with access to the equipment he is used to. In all cases, strict rules for endoscopic tools disinfection have to be followed. The main indications are sepsis due to acute cholangitis and acute severe pancreatitis mostly due to a biliary stone. In spite of difficult conditions linked to the patient status, technical success of ERCP is close to 100% with few complications. Nevertheless mortality can reach 55% mostly by multi-organs failure. To cite this journal: Acta Endosc. 42 (2012).

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Biliary decompression by nasobiliary catheter or biliary stent in acute suppurative cholangitis: A prospective randomized trial

Cited by 40 publications

References 0 publications

Endoscopic Biliary Drainage by 7 Fr or 10 Fr Stent Placement in Patients with Acute Cholangitis

Endoscopic Biliary Drainage by 7 Fr or 10 Fr Stent Placement in Patients with Acute Cholangitis

Diagnosis and Management of Acute Cholangitis

Quelles sont les vraies indications de la cholangiopancréatographie rétrograde endoscopique (CPRE) en urgence ?

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