Evaluation of the results of choledochoduodenostomy

Wright, N. L.

doi:10.1002/bjs.1800550110

Cited by 9 publications

(2 citation statements)

References 3 publications

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“…This is due mainly to the fear of potential risks such as bleeding, perforation, pancreatitis, and infection [8,9]. Fortunately, none of our patients developed these complications.…”

Section: Discussionmentioning

confidence: 80%

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Endoscopic Choledochoduodenostomy (ECDT): A Practical Approach to Management of Impacted Papillary Gallstones and Ampullary Tumors

1992

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We report five cases of impacted papillary stones and two cases of ampullary carcinoma treated by endoscopic choledochoduodenostomy (ECDT) at Riyadh Armed Forces Hospital (RAFH).The procedure was carried out successfully in all five cases with impacted stones and in one of the two cases of ampullary carcinoma. No complications were noted. In the presence of the necessary endoscopic expertise and in cases of impossible cannulation of the papilla of Vater due to stone impaction or the presence of a papillary tumor, we recommend endoscopic choledochoduodenostomy (ECDT). This approach provides an access to the common bile duct thus allowing appropriate therapeutic procedures on the biliary system to be performed. Endoscopic removal of common bile duct (CBD) stones is an established, effective, and safe procedure, particularly in the very sick and elderly [1][2][3]. However, cannulating the papilla is not always successful and even in experienced hands, there is a failure rate of 10% to 15% [4]. This is particularly the case when gallstones are impacted in the para-papillary region or there are occluding tumors rendering cannulation of the papillary orifice impossible.Endoscopic choledochoduodenostomy (ECDT) was introduced as an alternative procedure for these sort of cases [5,6] and the results have so far been encouraging. Its indications include both impacted papillary stones and palliative treatment for bile duct and ampullary cancer [7].Between 1984 and 1989, we treated seven patients; five with impacted papillary stones and two with ampullary carcinoma using ECDT at the Gastroenterology Unit in Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia. This report describes the procedure in these seven patients and discusses its indications, morbidity, and outcome. Patients and MethodsA total of seven cases (five men and two women) age group 32 to 86 years (mean 59 years) with cholestatic jaundice were managed by the ECDT at the Gastroenterology Unit, Riyadh Armed Forces Hospital.Prior to treatment, all patients were admitted to the hospital, clinically examined, and the relevant blood tests and abdominal ultrasound examinations were performed. At endoscopy, routine premedication with midazolam and buscopan were given intravenously. A side-view duodenoscope (Videoscope JFX IT or IT10) was used.At endoscopy, the papilla was swollen (Figure 1a). After several unsuccessful attempts to cannulate the papilla with a conventional sphincterotome, this was removed and replaced by a needle knife (5 mm wire papillotome). A small incision was then carefully made on the roof of the papilla 1 to 1.5 cm proximal to the assumed site of the orifice and below the transverse duodenal fold (Figures lb and 1c). The flow of bile indicated the establishment of a communication between the common bile duct and duodenal lumen (Figure 1d). The conventional sphincterotome was then reintroduced and contrast was injected to visualize the biliary tree, and the cut further extended superiorly

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“…This is due mainly to the fear of potential risks such as bleeding, perforation, pancreatitis, and infection [8,9]. Fortunately, none of our patients developed these complications.…”

Section: Discussionmentioning

confidence: 80%

“…In studies carried out on patients with surgically fashioned choledochoduodenal fistulae, the long-term complication of the sump syndrome has been noted [8,9,11]. In this syndrome, the duodenobiliary reflux results in accumulation of debris and recurrent stones with or without bacterial proliferation in the blind sac.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Choledochoduodenostomy (ECDT): A Practical Approach to Management of Impacted Papillary Gallstones and Ampullary Tumors

1992

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Sump syndrome following choledochoduodenostomy and its endoscopic treatment

Baker

Neoptolemos

Carr‐Locke

et al. 1985

Journal of British Surgery

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The clinical features of eight patients with 'sump syndrome' following side-to-side choledochoduodenostomy are reported. The syndrome is defined and its aetiology discussed with special reference to debris in the common bile duct, bacterial overgrowth and the clinical picture of acute cholangitis, which does not appear to be necessary for the diagnosis to be made. Five patients were successfully treated by endoscopic sphincterotomy and a sixth by endoscopic removal of food debris from the sump. The other two patients had further surgery.

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Biliary Fistulas and Anastomoses

Niederle

1981

Surgery of the Biliary Tract

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Evaluation of the results of choledochoduodenostomy

Cited by 9 publications

References 3 publications

Endoscopic Choledochoduodenostomy (ECDT): A Practical Approach to Management of Impacted Papillary Gallstones and Ampullary Tumors

Endoscopic Choledochoduodenostomy (ECDT): A Practical Approach to Management of Impacted Papillary Gallstones and Ampullary Tumors

Sump syndrome following choledochoduodenostomy and its endoscopic treatment

Biliary Fistulas and Anastomoses

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