Impact of Cholangioscopy: Diagnosing Sclerosing Cholangitis-Associated Biliary Calculi not Detected Using MRI and Endoscopic Ultrasound
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"documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2018;17:332-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 137 "formatos" => array:3 [ "EPUB" => 14 "HTML" => 62 "PDF" => 61 ] ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Incomplete Kawasaki Disease in an Infant with Cholangitis Post Kasai Surgery for Biliary Atresia" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "332" "paginaFinal" => "334" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Naman S. Shetty, Ira Shah" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Naman S." "apellidos" => "Shetty" ] 1 => array:2 [ "nombre" => "Ira" "apellidos" => "Shah" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119301668?idApp=UINPBA00004N" "url" => "/16652681/0000001700000002/v1_201905140709/S1665268119301668/v1_201905140709/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1665268119301644" "issn" => "16652681" "doi" => "10.5604/01.3001.0010.8663" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "70041" "copyright" => "Fundación Clínica Médica Sur, A.C." "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2018;17:318-29" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 186 "formatos" => array:3 [ "EPUB" => 13 "HTML" => 112 "PDF" => 61 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Bacterial Translocation Is Linked to Increased Intestinal IFN-γ, IL-4, IL-17, and mucin-2 in Cholestatic Rats" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "318" "paginaFinal" => "329" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 246 "Ancho" => 369 "Tamanyo" => 10330 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Intestinal bacterial load of Escherichia/Shigella by qPCR. Amplification was carried out by detection of 16S rDNA of Escherichia/Shigella. Bacterial concentration from each fecal sample was calculated by comparing the CT values obtained from the standard curve of E. coli (1 × 10<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> - 1 × 10<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> CFU/mL). Results were expressed as the mean ± SD. Five rats per group. * p ≤ 0.05, **p ≤ 0.01, ***p ≤ 0.001.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Natali Vega-Magaña, Vidal Delgado-Rizo, Leonel García-Benavides, Susana del Toro-Arreola, Jorge Segura-Ortega, Adelaida Sara M. Zepeda Morales, José Sergio Zepeda-Nuño, Marta Escarra-Senmarti, Jorge Gutiérrez-Franco, Jesse Haramati, Miriam R. Bueno-Topete" "autores" => array:11 [ 0 => array:2 [ "nombre" => "Natali" "apellidos" => "Vega-Magaña" ] 1 => array:2 [ "nombre" => "Vidal" "apellidos" => "Delgado-Rizo" ] 2 => array:2 [ "nombre" => "Leonel" "apellidos" => "García-Benavides" ] 3 => array:2 [ "nombre" => "Susana del" "apellidos" => "Toro-Arreola" ] 4 => array:2 [ "nombre" => "Jorge" "apellidos" => "Segura-Ortega" ] 5 => array:2 [ "nombre" => "Adelaida Sara M. Zepeda" "apellidos" => "Morales" ] 6 => array:2 [ "nombre" => "José Sergio" "apellidos" => "Zepeda-Nuño" ] 7 => array:2 [ "nombre" => "Marta" "apellidos" => "Escarra-Senmarti" ] 8 => array:2 [ "nombre" => "Jorge" "apellidos" => "Gutiérrez-Franco" ] 9 => array:2 [ "nombre" => "Jesse" "apellidos" => "Haramati" ] 10 => array:2 [ "nombre" => "Miriam R." "apellidos" => "Bueno-Topete" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119301644?idApp=UINPBA00004N" "url" => "/16652681/0000001700000002/v1_201905140709/S1665268119301644/v1_201905140709/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "titulo" => "Impact of Cholangioscopy: Diagnosing Sclerosing Cholangitis-Associated Biliary Calculi not Detected Using MRI and Endoscopic Ultrasound" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "330" "paginaFinal" => "331" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Waleed Fateen, Nick Taylor, Martin W. James" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Waleed" "apellidos" => "Fateen" "email" => array:1 [ 0 => "waleed.fateen@nottingham.ac.uk" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Nick" "apellidos" => "Taylor" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">**</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Martin W." "apellidos" => "James" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "National Institute for Health Research (NIHR) Biomedical Research Centre in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and the University of Nottingham" "etiqueta" => "*" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Derby Digestive Disease Centre, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK" "etiqueta" => "**" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 465 "Ancho" => 832 "Tamanyo" => 46184 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">A.</span> ERCP cholangiography showing CBD indentations and strictured CHD. <span class="elsevierStyleBold">B.</span> Prominent intra-hepatic biliary radicle beading. <span class="elsevierStyleBold">C.</span> Cholangioscopy appearances of the distal CBD showing “trachealisation”, diverticulae (red arrows) and a narrow CHD stricture. <span class="elsevierStyleBold">D.</span> cholangioscopic appearances of the CHD stricture post-balloon dilatation showing post dilatation disruption of the biliary mucosa. <span class="elsevierStyleBold">E.</span> Biopsy obtained from the common hepatic duct stricture. F. Proximal cholangioscopic appearances showing small stone fragments and debris.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0005">Case Report</span><p id="p0005" class="elsevierStylePara elsevierViewall">A 77 years old male patient presented five years earlier with painless jaundice and symptomatic cholangitis requiring hospital admission. He was fit and well otherwise. An endoscopic retrograde cholangio-pancreatography (ERCP) showed intra- and extra-hepatic biliary stricturing and beading suggestive of sclerosing cholangitis. No apparent triggers such as gallstones or inflammatory pancreatitis were identified, and he had no other systemic symptoms. He continued to suffer from recurrent attacks of cholangitis despite treatment with ursodeoxycholic acid 500 mg twice daily (14 mg/kg). This was mostly managed at home using short courses of oral antibiotics. He subsequently developed recurring symptoms of lethargy, itching and loss of appetite which resulted in 5.5 kg weight loss. This required further hospitalization three years after the initial presentation. Bilirubin levels were mostly normal and alkaline phosphatase approximately twice the upper limit of normal. A magnetic resonance cholangio-pancreatography (1.5 Tesla MRCP) showed a new 3 cm long common hepatic duct (CHD) indeterminate stricture near the hilum along with sclerosing cholangitis-related features previously demonstrated on ERCP. Blood CA19.9 was 58kU/L (normal range 0–27) and IgG4 levels were normal. EUS showed a 10 mm hilar lymph node with benign cytology using 25G FNA. He was referred to our unit for further cholangioscopic characterisation using single operator peroral cholangioscopy (SOPC; Spyglass DS® Boston Scientific).</p><p id="p0010" class="elsevierStylePara elsevierViewall">Initial cholangiography showed CBD indentations and a strictured CHD followed by prominent intra-hepatic beading of biliary radicles (<a class="elsevierStyleCrossRef" href="#f0005">Figures 1</a>A and 1B). Common bile duct (CBD) intubation with SOPC did not show the usual smooth pearly appearance but instead demonstrated a fibrotic-appearing duct with numerous band-like scars and diverticulae, identified by the red arrows (<a class="elsevierStyleCrossRef" href="#f0005">Figure 1</a>C). More proximally, stricturing was prominent in the common hepatic duct (CHD) and initially the 10.5Fr SpyGlass DS® cholangioscope could not pass. Following 6 mm intraductal balloon dilatation (Titan® balloon, Cook Medical) the cholangioscope could traverse the CHD stricture to access hilar structures. Post-dilatation disruption of the biliary mucosa can be seen post-balloon dilatation (<a class="elsevierStyleCrossRef" href="#f0005">Figure 1</a>D). This revealed small stone fragments and debris, likely secondary to chronic cholestasis in the biliary tree (<a class="elsevierStyleCrossRef" href="#f0005">Figure 1</a>F). Analysis of cytology brushings and biliary (Spybite®) biopsies confirmed benign appearances with no evidence of cholangiocarcinoma (<a class="elsevierStyleCrossRef" href="#f0005">Figure 1</a>E). Balloon dilatation was performed in an attempt to access hilar ducts and improve biliary drainage. On follow up 1-year post-dilatation, the patient had an uneventful course with no further attacks of cholangitis.</p><elsevierMultimedia ident="f0005"></elsevierMultimedia><p id="p0015" class="elsevierStylePara elsevierViewall">Primary sclerosing cholangitis (PSC) is a progressive disease of the liver. In the absence of a reversible causative factor it can result in cirrhosis and hepatic decompensation, as well as cause recurrent progressive suppurative cholangitis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Direct endoscopic examination and sampling using cholangioscopy may help to distinguish between malignant or benign causes of biliary structuring including IgG4 disease, secondary sclerosing cholangitis and cholanagiocarcinoma.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However, understanding and interpreting cholangioscopic endoscopic images alone to make a diagnosis can be unreliable and further improvements in image and tissue acquisition (e.g. biopsy size) will make diagnosis more robust.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Careful examination of the MRCP images in multidisciplinary team settings in this case triggered the referral for cholangioscopy. This lead to a definitive diagnosis and management after four years of cholangitis.</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0010">Competing Interest</span><p id="p0020" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0005"><li class="elsevierStyleListItem" id="u0005"><span class="elsevierStyleLabel">•</span><p id="p0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">WF:</span> None declared.</p></li><li class="elsevierStyleListItem" id="u0010"><span class="elsevierStyleLabel">•</span><p id="p0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">NT:</span> None declared.</p></li><li class="elsevierStyleListItem" id="u0015"><span class="elsevierStyleLabel">•</span><p id="p0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">MJ:</span> Advisor to Boston Scientific and Cook Medical.</p></li></ul></p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Provenance and Peer Review</span><p id="p0040" class="elsevierStylePara elsevierViewall">Not commissioned, internally peer reviewed.</p></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Consent</span><p id="p0045" class="elsevierStylePara elsevierViewall">Patient informed consent was obtained for publication.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "s0005" "titulo" => "Case Report" ] 1 => array:2 [ "identificador" => "s0010" "titulo" => "Competing Interest" ] 2 => array:2 [ "identificador" => "s0015" "titulo" => "Provenance and Peer Review" ] 3 => array:2 [ "identificador" => "s0020" "titulo" => "Consent" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-08-24" "fechaAceptado" => "2017-11-16" "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "f0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 465 "Ancho" => 832 "Tamanyo" => 46184 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">A.</span> ERCP cholangiography showing CBD indentations and strictured CHD. <span class="elsevierStyleBold">B.</span> Prominent intra-hepatic biliary radicle beading. <span class="elsevierStyleBold">C.</span> Cholangioscopy appearances of the distal CBD showing “trachealisation”, diverticulae (red arrows) and a narrow CHD stricture. <span class="elsevierStyleBold">D.</span> cholangioscopic appearances of the CHD stricture post-balloon dilatation showing post dilatation disruption of the biliary mucosa. <span class="elsevierStyleBold">E.</span> Biopsy obtained from the common hepatic duct stricture. F. Proximal cholangioscopic appearances showing small stone fragments and debris.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0010" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "European Society of Gastrointestinal Endoscopy; European Association for the study of the Liver" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2017.02.013" "Revista" => array:6 [ "tituloSerie" => "J Hepatol" "fecha" => "2017" "volumen" => "66" "paginaInicial" => "1265" "paginaFinal" => "1281" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28427764" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prospective evaluation of the clinical utility of single-operator peroral cholangioscopy in patients with primary sclerosing cholangitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Arnelo U." 1 => "von Seth E." 2 => "Bergquist A." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-0034-1391845" "Revista" => array:6 [ "tituloSerie" => "Endoscopy" "fecha" => "2015" "volumen" => "47" "paginaInicial" => "696" "paginaFinal" => "702" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25826274" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Digital, single-operator cholangiopancreatoscopy in the diagnosis and management of pancreatobiliary disorders: a multicenter clinical experience (with video)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Navaneethan U." 1 => "Hasan M.K." 2 => "Kommaraju K." 3 => "Zhu X." 4 => "Hebert-Magee S." 5 => "Hawes R.H." 6 => "Vargo J.J." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Gastrointest Endose" "fecha" => "2016" "volumen" => "84" "paginaInicial" => "649" "paginaFinal" => "655" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Triple modality testing by endoscopic retrograde cholangiopancreatography for the diagnosis of cholangiocarcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Nanda A." 1 => "Brown J.M." 2 => "Berger S.H." 3 => "Lewis M.M." 4 => "Barr Fritcher E.G." 5 => "Gores G.J." 6 => "Keilin S.A." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/1756283X14564674" "Revista" => array:6 [ "tituloSerie" => "Therap Adv Gastroenterol" "fecha" => "2015" "volumen" => "8" "paginaInicial" => "56" "paginaFinal" => "65" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25729431" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/16652681/0000001700000002/v1_201905140709/S1665268119301656/v1_201905140709/en/main.assets" "Apartado" => array:4 [ "identificador" => "77723" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Image in Hepatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/16652681/0000001700000002/v1_201905140709/S1665268119301656/v1_201905140709/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119301656?idApp=UINPBA00004N" ]
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