1/2. Oral contrast-enhanced CT cholangiography--an initial experience.OBJECTIVE: To describe our experience of CT (Computed tomographic) cholangiography examination for detection of choledocholithiasis at the Aga Khan University Hospital (AKUH) Karachi pakistan. methods: Seven patients underwent helical CT cholangiography for suspected choledocholithiasis. iopanoic acid (6 grams) was administered orally 8-12 hours before acquisition of a helical CT cholangiogram. Three-dimensional reconstructions and curved multiplanar reformations were generated from a set of axial source images. RESULTS: Our patients had no adverse reactions to iopanoic acid. The degree of biliary opacification was sufficient to perform three-dimensional and curved planar reformations in 5 patients. In two patients, the biliary tree was not opacified. Both of these studies were considered failures. Findings on CT cholangiography in the remaining 5 patients were the following: cholelithiasis with normal bile duct (n=2), choledocholithiasis (n=1), stone in gallbladder remnant with long cystic duct (n=1) and infiltrating adenocarcinoma of the gallbladder (n=1). CONCLUSION: Spiral CT cholangiography is a safe, non-invasive, and cost effective alternative test and, in a carefully selected patient population can play a role in the diagnostic work-up of patients with suspected choledocholithiasis.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
2/2. Endoscopic direct cholangioscopy by using an ultra-slim upper endoscope: a feasibility study.BACKGROUND: The search for an easier and less cumbersome technique to perform direct visual examination of the biliary tree is still underway. OBJECTIVE: To assess the feasibility of performing endoscopic direct cholangioscopy utilizing an ultra-slim upper endoscope designed for pediatric patients. DESIGN: Prospective, observational, pilot study. SETTING: Tertiary referral center. patients: Three patients who underwent endoscopic retrograde cholangiography for evaluation and treatment of choledocholithiasis. methods: Following the completion of the endoscopic retrograde cholangiography, a 0.035-inch diameter super-stiff Jagwire (boston Scientific Corp, Natick, Mass) was placed in the common bile duct. Using the wire to maintain access, we removed the duodenoscope and backloaded the wire onto an ultra-slim upper endoscope (GIF-XP 160, Olympus America Inc, Melville, NY), which was advanced over the guidewire under fluoroscopic and endoscopic control into the duodenum and then across the ampulla of vater into the common bile duct and upstream. RESULTS: Endoscopic direct cholangioscopy was attempted and successfully completed in all 3 patients. One patient was found to have persistent large amount of sludge and stones, and was referred for surgery. In the other two patients, endoscopic direct cholangioscopy demonstrated complete duct clearance, obviating the need for stent placement and repeat endoscopic retrograde cholangiography procedures. LIMITATIONS: Small sample size, pilot study. CONCLUSIONS: Endoscopic direct cholangioscopy with an ultra-slim upper endoscope originally designed for pediatric use is feasible. Future advances in endoscope development, as well as specifically designed accessories, could lead to the next generation of intraductal diagnosis and therapy.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |