Hi guys, Welcome to the Advanced Video Search Engine, and you are watching ERCP FOR “INCIDENTAL” CHOLEDOCHOLITIASIS ?. That video is uploaded by monzahmed at 2022-10-02T10:37:42-07:00. We are promoting this video only for entertainment and educational purpose only. So, I hope you like & enjoy it. [KBB1-7ZGJfA]
| Name | ERCP FOR “INCIDENTAL” CHOLEDOCHOLITIASIS ? |
| Video Uploader | Video From monzahmed |
| Upload Date | This Video Uploaded At 02-10-2022 17:37:42 |
| Video Discription | An 84 year old lady with a past history of dementia and a recent hemiarthroplasty for fractured left neck of femur presented to hospital with confusion, loose stools with weight loss. There was no abdominal pain. Initial investigations were as follows: - Hb 10.9 g/dL, WBC 4.45, platelets 340 - Bilirubin 35 umol/L (NR less than 17) , ALT 92 iu (NR less than 55), Alk Phosp 500 iu (NR less than130) - U/S: stones in GB, 15mm stone in dilated CBD, dilated IHDs, 2.4cm AAA - CT TAP: dilated IHDs and CBD + stone in the distal CBD In view of the finding of choledocholitiasis, an ERCP was performed (see video…) — Although the results of the ERCP procedure was satisfying, the question is, should patients with asymptomatic or incidental choledocholitiasis have an ERCP? Choledocholithiasis is a common finding in clinical practice, with presentation varying from asymptomatic to life-threatening complications such as pancreatitis and cholangitis. In symptomatic patients, there is no doubt that treatment to clear the bile duct is indicated, but there is still a debate regarding the treatment of patients with asymptomatic (or incidental) common bile duct stones (CBDS). This presence of CBDS can be secondary to passing of a stone from the gallbladder into the bile duct (more common in Western patients), or the stone may be formed de-novo inside the CBD (more common in the Asian/ Chinese population) [1]. The prevalence of CBDS in patients with *symptomatic* gallstones is estimated to be 10%-20% [2-6]. In patients without jaundice and dilated CBD on trans-abdominal ultrasound, the prevalence of CBDS during cholecystectomy is reported to be less than 5% [7]. It has been reported that the rate of coexisting CBDS was increased in elderly populations with symptomatic gallstones [8]. However, there are no studies focusing on the prevalence of CBDS in patients with *asymptomatic* gallstones, as most studies are based on intraoperative cholangiography during cholecystectomy for symptomatic gallstones. Although the prevalence of CBDS is expected to increase due to the ageing of world population, the prevalence of asymptomatic CBDS is still unknown. Five international guidelines all recommend extraction of asymptomatic CBDS with ERCP as the first choice of treatment, although the evidence is of low quality: - ESGE 2019 [9]: ESGE recommends stone extraction in all patients with CBDS, regardless of being symptomatic or not, who are fit enough to tolerate the intervention. (Strong recommendation, low quality evidence) - NICE 2014 [10]: offer bile duct clearance and cholecystectomy to people with symptomatic or asymptomatic CBD stones. - BSG 2017 [11]: stone extraction is recommended in patients diagnosed with CBDS if possible. Evidence of benefit of stone extraction is greatest for symptomatic patients (Low quality evidence; strong recommendation) - JGES 2017 [12]: asymptomatic choledocholithiasis should be treated because of a risk of developing biliary complications. [Evidence level: A; Strength of recommendation (agreement rate): 2 (100%)] - ASGE 2011 [13]:CBDS should be treated if detected regardless of the presence or absence of significant mitigating clinical circumstances (Moderate quality) continued in first comment.... KBB1-7ZGJfA |
| Category | Education |
| Tags | endoscopy | gut | GI tract | medicine | gastroenterology | monz | monz ahmed | monzahmed | monzur ahmed | ERCP | choledocholitiasis | asymptomatic | gallstones | complications | pancreatitis | cholangitis |
