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1
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18-year old patient with extrahepatic biliary duct carcinoid – case report

100%
Rykała C., Bartosiewicz J., Pawlak J., Nawrocka-Kunecka A., Omulecka A.
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vol. 86
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issue 1
39-43
EN
Most patients with obstructive jaundice caused by an etiology other than choledocholithiasis are at risk of adenocarcinoma development. Other types of tumors are less common, although more benign. The presented study described management in case of liver hilar tumors with special regards to common hepatic duct carcinoids
2
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ERCP with Removal of Concrements Through Choledocho-Duodenal Fistula - A Case Report

100%
Sebastian M., Wierzbicki J., Rudnicki J.
Polish Journal of Surgery
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2010
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vol. 82
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issue 5
289-291
EN
Spontaneous choledocho-duodenal fistula is mostly associated with choledocholithiasis. Symptoms of fistula are non-specific therefore its diagnosis is usually made incidentally during diagnosis of other bile duct diseases. ERCP is a method which plays the basic role in diagnosis and treatment of fistula between common bile duct and duodenum.
3
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Endoscopic Treatment of the Choledocholithiasis - Effectiveness, Safety and Limitations of the Method

100%
Peterlejtner T., Szewczyk T., Firkowski P., Zdrojewski M.
Polish Journal of Surgery
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2012
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vol. 84
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issue 7
333-340
EN
Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is accepted referred method of treatment of the choledocholithiasisThe aim of the study. Evaluation of efficacy and safety of the endoscopic treatment of the biliary tract stones.Material and methods. Results of 3309 Endoscopic Retrograde Cholangio-Pancreatography (ERCP) carried out in Division of Endoscopy of the General Surgery Department in the period 2000 - 2010. The retrospective analysis of the indications, process, findings and final results of 1698 ERCP and Endoscopic Sphincterotomy (ES) was performed with intention to treat of the biliary tract stones.Results. The 883 (52%)patients with coexisted gall-bladder and biliary tract stones were the principal group. The second group included 580 (34.2%) patients with residual choledocholithiasis after cholecystectomy and biliary tract surgery. Moreover ERCP, ES and endoscopic evacuation of biliary stones have been urgently carried out in 159 (9.4%) cases with acute biliary pancreatitis. Lastly ERCP with re-sphincterotomy and removal of the stones was performed in 75 (4.4%) patients with recurrent choledocholithiasis. The procedure was effective in 1561 (92%) patients. When removal of the stones was not possible, decompression of the biliary tract by implantation of the plastic stent was done in 63 (3.7%) cases. Ineffective procedure was noted in 74 (4.3%) patients. The most commonly observed complication was acute pancreatitis. Because of: post ES bleeding, acute haemmorhagic and necrotic pancreatitis, impacted Dormia basket and peripapillary duodenal perforation 10 patients (0.5%) had to be operated. Two patients (0.1%) died.Conclusions. 1. Endoscopic treatment of choledocholithiasis is highly effective but risk factors of complications with urgency an intensive conservative management and surgical intervention have to be considered. 2. After ES, if surgical evacuation of the stones have to be carry out, post operative biliary tract drainage (by T tube) is not necessary.
4
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A periampullary duodenal diverticula in patient with choledocholithiasis – single endoscopic center experience

88%
Major P., Dembiński M., Winiarski M., Pędziwiatr M., Rubinkiewicz M., Stanek M., Dworak J., Pisarska M., Rembiasz K., Budzyński A.
Polish Journal of Surgery
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2016
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vol. 88(6)
576-586
EN
The reported prevalence of periampullary duodenal diverticula varies between 9 and 32.8%. The aim of the study was to evaluate the prevalence of periampullary diverticula in the studied population and establish whether their presence influence the risk of choledocholithiasis and the risk of Endoscopic Retrograde Cholangio Pancreatography (ERCP) related complications. Material and methods. The study group of 3788 patients who underwent ERCP between 1996 and 2016at the 2nd Department of General Surgery Jagiellonian University Medical College in Kraków were analyzed. The group comprised of 2464 women (mean age 61.7 years) and 1324 men (mean age 61.8 years). The patients were divided into two groups. Group A included patients in whom there were no periampullary diverticula detected. Group B included patients in whom the opening of the bile duct was in the vicinity of a duodenal diverticulum. Results. There were 3332 patients included in group A (2154 women and 1178 men) and 456 patients in group B (310 women and 146 men). The prevalence of periampullary duodenal diverticula in the analyzed group was 12.8%. The presence of stones or biliary sludge was diagnosed in 1542 patients (47.6%) in group A and 290 patients (68.1%) in group B. Recurrence of choledocholithiasis occurred in 4.5% of patients (70/1542) in group A and 10.3% of patients (30/290) in group B. Complications occurred in a total of 76 patients in group A (2.3%) and 22 patients in group B (4.8%). Conclusions. The presence of choledocholithiasis and the risk of ERCP related complications are significantly higher in the group with duodenal diverticula.
5
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Endoskopowa ultrasonografia czy endoskopowa cholangiopankreatografia w diagnostyce kamicy żółciowej przewodowej?

75%
Leszczyszyn J.
Journal of Ultrasonography
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2014
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vol. 14
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issue 57
125-129
EN
It is estimated that 3.4% of patients qualified for cholecystectomy due to cholelithiasis have a coexisting choledocholithiasis. For decades, endoscopic ascending retrograde cholangiopancreatography has been the golden diagnostic standard in cases of suspected choledocholithiasis. The method is associated with a relatively high rate of complications, including acute pancreatitis, the incidence of which is estimated to range between 0.74% and 1.86%. The mechanism of this ERCP-induced complication is not fully understood, although factors increasing the risk of acute pancreatitis, such as sphincter of Oddi dysfunction, previous acute pancreatitis, narrow bile ducts or difficult catheterization of Vater’s ampulla are known. It has been suggested to discontinue the diagnostic endoscopic retrograde ascending cholangiopancreatography and replace it with endoscopic ultrasonography due to possible and potentially dangerous complications. Endoscopic ultrasonography has sensitivity of 94% and specificity of 95% regardless of gallstone diameter, as opposed to magnetic resonance cholangiography. However, both of these parameters depend on the experience of the performing physician. The use of endoscopic ultrasonography allows to limit the number of performed endoscopic retrograde cholangiopancreatography procedures by more than 2/3. Ascending endoscopic retrograde cholangiopancreatography combined with an endoscopic incision into the Vater’s ampulla followed by a mechanical evacuation of stone deposits from the ducts still remains a golden standard in the treatment of choledocholithiasis. Despite some limitations such as potentially increased treatment costs as well as the necessity of the procedure to be performed by a surgeon experienced in both endoscopic retrograde cholangiopancreatography as well as endoscopic ultrasonography, the diagnostic endoscopic ultrasonography followed by a simultaneous endoscopic retrograde cholangiopancreatography aimed at gallstone removal is the most efficient diagnostic and therapeutic management scheme in cases of suspected choledocholithiasis.
PL
Kamica przewodu żółciowego u pacjentów zakwalifikowanych do cholecystektomii współistnieje z kamicą pęcherzyka żółciowego u 3,4% chorych. Od kilkudziesięciu lat standardem diagnostycznym w podejrzeniu kamicy żółciowej przewodowej była endoskopowa cholangiopankreatografia wstępująca. Metoda ta obarczona jest relatywnie wysokim odsetkiem powikłań w postaci ostrego zapalenia trzustki, którego częstość ocenia się na 0,74% do 1,86%. Mechanizm tego powikłania po diagnostycznym ERCP nie jest do końca zrozumiały, choć znane są czynniki zwiększające prawdopodobieństwo ostrego zapalenia trzustki, takie jak: zaburzenia motoryki zwieracza Oddiego, przebyte wcześniej ostre zapalenie trzustki, wąskie przewody żółciowe czy trudna kaniulacja brodawki Vatera. Z powodu możliwych, potencjalnie groźnych dla życia powikłań postuluje się całkowite zaniechanie wykonywania diagnostycznej endoskopowej cholangiopankreatografii wstępującej i zastąpienie jej endoskopową ultrasonografią. Endoskopowa ultrasonografia cechuje się czułością 94% i specyficznością 95%. Cechy te są niezależne od średnicy złogów, w przeciwieństwie do cholangiografii w rezonansie magnetycznym, natomiast związane są z doświadczeniem lekarza wykonującego badanie. Zastosowanie endoskopowej ultrasonografii pozwala ograniczyć liczbę wykonywanych endoskopowych cholangiopankreatografii o ponad 2/3. Endoskopowa cholangiopankreatografia wstępująca połączona z endoskopowym nacięciem zwieracza brodawki Vatera i mechaniczną ewakuacją złogów z przewodu nadal pozostaje złotym standardem w leczeniu kamicy przewodowej. Pomimo pewnych wad, takich jak potencjalnie zwiększony koszt leczenia, konieczność wykonywania zabiegu przez lekarza doświadczonego zarówno w endoskopowej cholangiopankreatografii, jak i endoskopowej ultrasonografii, najbardziej efektywnym schematem postępowania diagnostyczno-terapeutycznego w przypadku podejrzenia kamicy przewodowej, jest wykonanie diagnostycznej endoskopowej ultrasonografii, z następową, jednoczasową endoskopową cholangiopankreatografią celem usunięcia złogów.
6
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Ultrasonografia endoskopowa (EUS) w diagnostyce i leczeniu kamicy przewodów dróg żółciowych. Współczesna rola ECPW

63%
Kiełtucki J.
Annales Academiae Medicae Silesiensis
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2017
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vol. 71
326-330
EN
Precise evaluation of the presence of bile duct stones, performed using the most non-invasive method, is important for the planning of optimal treatment. Not only simple imaging procedures (like conventional transabdominal ultrasound – US) but also more sophisticated imaging methods (CT or MRI) are frequently unreliable. The optimal method of bile duct stone non-invasive diagnostics is magnetic resonance cholangiography. The role of endoscopic retrograde cholangiopancreatography in diagnostics has receded into the background due to the possibility of numerous serious complications. Despite some limitations such as potentially increased treatment costs as well as the necessity of the procedure to be performed by a surgeon experienced in both endoscopic retrograde cholangiopancreatography as well as endoscopic ultrasonography, diagnostic endoscopic ultrasonography followed by simultaneous endoscopic retrograde cholangiopancreatography aimed at gallstone removal is the most efficient diagnostic and therapeutic management scheme in cases of suspected choledocholithiasis. The use of endoscopic ultrasonography allows one to limit the number of performed endoscopic retrograde cholangiopancreatography procedures by more than 2/3. Ascending endoscopic retrograde cholangiopancreatography combined with an endoscopic incision into the ampulla of Vater followed by mechanical evacuation of stone deposits from the ducts still remains a the optimal procedure in the treatment of choledocholithiasis.
PL
Precyzyjna diagnostyka obecności kamicy żółciowej przewodowej, przeprowadzona możliwie najmniej inwazyjnymi metodami, jest ważna przy podejmowaniu decyzji terapeutycznych. Nie tylko proste badania (jak konwencjonalna ultrasonografia – USG), ale też bardziej wyszukane metody obrazowania (tomografia komputerowa, rezonans magnetyczny) są często zawodne. Złotym standardem nieinwazyjnej diagnostyki kamicy przewodowej jest cholangiografia rezonansu magnetycznego – cholangio MRI. Rola cholangiopankreatografii wstecznej – ECPW w diagnostyce nieco przesunęła się na dalszy plan, ze względu na możliwość licznych istotnych powikłań. Pomimo pewnych wad, takich jak potencjalnie zwiększony koszt leczenia, konieczność wykonywania zabiegu przez lekarza doświadczonego zarówno w endoskopowej cholangiopankreatografii, jak i endoskopowej ultrasonografii, najbardziej efektywnym schematem postępowania diagnostyczno-terapeutycznego w przypadku podejrzenia kamicy przewodowej jest wykonanie diagnostycznej endoskopowej ultrasonografii z następową, jednoczasową endoskopową cholangiopankreatografią celem usunięcia złogów. Zastosowanie endoskopowej ultrasonografii pozwala ograniczyć liczbę wykonywanych endoskopowych cholangiopankreatografii o ponad 2/3. Endoskopowa cholangiopankreatografia wsteczna połączona z endoskopowym nacięciem zwieracza brodawki Vatera i mechaniczną ewakuacją złogów z przewodu nadal pozostaje złotym standardem w leczeniu kamicy przewodowej.
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