Improving biliary-enteric drainage with primary sclerosing cholangitis: experience with endoscopic methods

Article Abstract:

Primary sclerosing cholangitis is an often fatal inflammatory disease affecting the bile ducts. To date, there is no satisfactory treatment for this condition; in particular, drug treatment has not proven efficacious, and surgical treatment is at too preliminary a stage to draw firm conclusions. To further evaluate the effectiveness of using endoscopic methods to implant a drainage device, a study was carried out in which six patients with jaundice (an externally detectable symptom of liver or biliary system abnormalities) and known or suspected primary sclerosing cholangitis underwent placement of an endoprosthesis. In this case, the endoscopic procedure involves viewing and manipulating the liver and bile ducts by means of a flexible fiber-optic endoscope inserted through the esophagus into the small intestine; the endoprosthesis is a tube-like device implanted in the constricted bile ducts to allow bile flow from the liver to the intestine. Five of the six patients showed dramatic improvement within several weeks of endoprosthesis placement; both clinical indices and blood chemistry results indicated a significant improvement in liver function. The remaining patient required a liver transplant five months following surgery, owing to continued deterioration of liver function. During follow-up periods ranging from 12 to 49 months in the five improved patients, the endoscopically placed endoprostheses continued to provide relief from the symptoms of cholangitis; bile duct diameters were twice their presurgery sizes. Three of the patients developed infections at the time of initial endoprosthesis insertion; surgical drainage was necessary in one case. This technique yields higher success rates than have been reported with either traditional surgical or percutaneous methods (through the abdomen). In addition, the likelihood of complications interfering with possible future liver transplants is less with endoscopic methods. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Surgery, Endoscopic surgery

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Predicting cholangiocarcinoma in patients with primary sclerosing cholangitis before transplantation

Article Abstract:

Primary sclerosing cholangitis is a chronic inflammatory disorder of the liver and biliary system. The cause of the disease is not known, but it is characterized by fibrous constrictions of the bile ducts, and as many as 50 percent of symptomatic patients eventually develop liver failure. Primary sclerosing cholangitis is the second most common condition for which liver transplant is performed. Recent studies suggest that patients with primary sclerosing cholangitis are at increased risk for developing cholangiocarcinoma (cancer of the bile ducts). This type of cancer is difficult to diagnose in cholangitis patients due to the distortion that cholangitis imposes on the biliary system; currently, the only accurate method for diagnosing cholangiocarcinoma is complete examination of the liver and biliary system at autopsy or following complete surgical removal of the liver. To determine which clinical, radiological, and laboratory features of patients with end-stage primary sclerosing cholangitis might predict concurrent cholangiocarcinoma, the cases of 11 patients undergoing orthotopic (from a donor) liver transplant were studied. Four of the eleven patients were shown to have cholangiocarcinoma. This subset of patients manifested rapid-onset jaundice (yellow-tinged skin indicative of liver disease), pruritus (severe itching), as well as weight loss associated with increased blood levels of bilirubin and alkaline phosphatase over the course of a year prior to hospital admission. Radiological evaluation of the biliary system showed dilated intrahepatic (within the liver) bile ducts in most cholangiocarcinoma patients, compared with patients with simple sclerosing cholangitis. Following liver transplant, cholangiocarcinoma recurred in two of the four patients at 14 and 39 months, respectively; the remaining two patients showed no recurrence. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Complications and side effects, Risk factors, Liver, Liver transplantation, Gallbladder cancer

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Prospects for extracorporeal liver support

Article Abstract:

The goals of artificial liver support, the design of the existing liver support systems and the current status in the management of patients with liver failure are discussed. The molecular recirculating system (MARS) is increasingly used for the management of liver failure.

Science & research, Research, Liver failure, Artificial liver

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