Dante Manazzoni

Laparoscopic cholecystectomy complications: a new case report of a right hepatic artery pseudoaneurysm that caused jaundice

Iatrogenic vascular injuries of the hepatic artery are infrequent and a serious complication of LC. There is no doubt about the many advantages of LC when compared to open cholecystectomy. Despite this, there is an increase in the reported incidence (0.3%-1.0%) of biliary and vascular injuries. Most arterial complications are due to direct injury or diathermy shortening on surgical clips and HAP is one of them. We present a case of a 39-year old male patient who presented with this complication and how it was resolved.

Spectrum of biliary parasites affecting the biliary tree (Fasciola hepatica, Echinococcus granulosus, and Ascaris lumbricoides)

Parasites are common worldwide and may involve any part of the gastrointestinal tract. Despite the high prevalence, reports of biliary involvement and its endoscopic treatment are scarce. Hereby we present a spectrum of biliary tree parasitosis (▶Video1). Case 1 was an 18-year-old woman who presented to our institution with jaundice and pruritus. An abdominal ultrasound revealed mobile lamellae in the gallbladder and common bile duct. An endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy was performed. Multiple adult vital flatworms (Fasciola hepatica) were retrieved with a Dormia basket (▶Fig. 1). Intraductal instillation of 2.5% iodopovidone was performed, and we allowed it to act for 5 minutes by occluding the distal bile duct with a balloon [1]. Medical treatment with triclabendazole was then completed and the patient had an excellent clinical outcome. The second case was a 27-year-old man who was admitted with acute cholangitis. An abdominal computed tomography (CT) scan was performed. The common bile duct was dilated and a subhepatic cystic cavity was observed. We decided to perform an ERCP, during which an extrinsic compression of the duodenum was first observed. The cholangiography showed dilatation of the intraand extrahepatic bile ducts with heterogeneous distribution and filling of the contrast into the bile duct. The subhepatic cavity was also rapidly filled with contrast, so we assumed that it was in communication with the biliary tree (▶Fig. 2). A sphincterotomy was performed and we extracted multiple membranes, mucinous contents, and purulent bile with an extractor balloon. Subsequent medical treatment with albendazole was given with a good clinical response being achieved. Case 3 was a 72-year-old woman who presented with acute cholangitis. An abdominal computed tomography (CT) scan was performed. Multiple thin-walled cysts were observed in the liver with dilatation of the biliary tree. An ERCP with sphincterotomy was performed. The cholangiogram showed extrahepatic bile duct dilatation. The intrahepatic bile ducts of the right hepatic lobe seemed “displaced” by the presence of an occupying mass. Multiple hydatid membranes (Echinococcus granulosus) were extracted with a Dormia basket Video 1 Case 1 shows multiple adult vital flatworms (Fasciola hepatica) being retrieved with a Dormia basket. Case 2 shows the extraction of multiple membranes, mucinous contents, and purulent bile with an extractor balloon in a patient with a hydatid cyst and how the cyst is cleared at the end of the procedure. Case 3 shows the extraction of multiple membranes with a Dormia basket. Case 4 shows a large Ascaris lumbricoides being extracted with a stone retrieval basket.

Inserción de prótesis metálicas autoexpandibles totalmente recubiertas en patología biliar benigna

INTRODUCTION Benign biliary diseases are traditionally treated using plastic stents. However, fully covered self-expanding metal stents are currently gaining acceptance for the treatment of these pathologies. OBJECTIVE To assess the effectiveness and complications associated with the placement of temporary endoscopic fully covered self-expanding metal stents for the treatment of benign biliary diseases. MATERIALS AND METHODS This was a retrospective and observational study using a prospective database from a tertiary care center from March 2012 to May 2016. Some patients that had a fully covered metal stent due to a benign biliary disease were also included. The indications, resolution, technical success rates and adverse events were documented. RESULTS 31 patients were included with a total of 34 stents inserted. The indications were as follows: 8 (25%) post cholecystectomy biliary stenoses, 11 (31%) large or multiple choledocholithiasis, 3 (8.3%) biliary fistulas, 2 (6%) post-liver transplant stenoses, 2 (8.3%) papillary stenoses, 2 (6%) perforations and 2 (6%) bleeds. The global resolution success rate of the stents for all pathologies was 88%, this included 87.5% (7/8) in post cholecystectomy stenoses, 73% (8/11) in large choledocholithiasis and 100% for the remaining indications. Thirty-three of 34 stents were removed after an average of 133 days (ranging from 10 to 180 days). No complications were registered. CONCLUSION Fully covered self-expanding metal stents are an effective and reliable alternative for the resolution of benign biliary diseases.

787 Risk of Death and Thromboembolism in Patients That Do Not Resume Anticoagulation After an Episode of Peptic Ulcer Bleeding

Background: The existing literature regarding smoking and alcohol consumption and risk of gastrointestinal bleeding (GIB) is sparse and conflicting. In an attempt to study modifiable risk factors of GIB, we assessed the risk of GIB associated with smoking and alcohol consumption in a large prospective cohort of men. Methods: We studied 51,529 men in the Health Professional follow-up Study (HPFS) who were aged 40-75 years at baseline in 1986. We identified men with GIB requiring hospitalization and/or blood transfusion based on their responses to biennial questionnaires from 2006-2012 and reviewed medical records to validate self-report. Information about smoking and alcohol consumption was updated every two and four years, respectively. We used Cox proportional hazards regression to calculate the relative risks (RR) and 95% confidence intervals (CI) adjusting for age, study year, body mass index, physical activity, regular aspirin and nonsteroidal anti-inflammatory drug use, and alcohol/smoking. Results: We documented 311 episodes of GIB during a 26-year follow up period. After adjustments for other potential risk factors, individuals who consumed >15 g/day of alcohol had a multivariate RR of 1.65 (95% CI, 1.10-2.47; p for linear trend 0.004) when compared with men who did not consume alcohol. Intake of > 15 g/day of alcohol appeared to be primarily related to upper GIB (multivariable RR 1.74; 95% CI, 0.98-3.08; p for linear trend 0.007). Risk of GIB increased linearly with amount of liquor consumed (p for linear trend 15 g/day of alcohol was significantly associated with peptic ulcer disease (multivariable RR 1.85; 95% CI, 0.97-3.54; p for linear trend 0.02), but not esophagitis/gastritis/duodentitis, or diverticular bleeding. There were few cases of bleeding due to portal hypertension (n=4). Current and past smokers did not appear to have increased risk of GIB when compared to those who never smoked (multivariable RR 0.89; 95% CI, 0.45-1.76 and 1.12, 95% CI 0.88-1.41, respectively). We also did not find a significant association between pack years of smoking and risk of GIB (multivariable RR 1.01; 95% CI, 0.63-1.62 when comparing men with at least 45 pack-years of exposure to never smokers). Conclusions: In this large prospective study, alcohol consumption, but not smoking, was associated with an increased risk of GIB. Associations were most notable for upper GI bleeding associated with intake of liquor.

Su1243 Risk of Colonic Neoplasia in Patients With Sporadic Duodenal Adenomas: A Multicenter Case-Control Study

Background/Aims;In patients with gastric cancer, colorectal cancer is one of themost common synchronous cancers.Recently, preoperative colonoscopy for patients with gastric adenocarcinoma has been recommended. We aimed to assess the clinical value of colonoscopy by evaluating the frequency of colorectal neoplasm in patients with early gastric cancer(EGC) compared to healthy controls and analyzed the risk factors of advanced colorectal neoplasm in patients with EGC. Methods; The medical records of 203 patients who diagnosed as EGC and 201 healthy control matched sex and age were reviewed retrospectively. All of the subjects underwent colonoscopy for routine check-up. The frequency and clinical feature of the colorectal polyp were assessed and compared with control group. Risk factors of advanced colorectal neoplasm(high grade dysplasia, size ≥1cm, with villous component, carcinoma in situ and intramucosal cancer) in EGC were also analyzed. Results;Mean age of the patients was 61±10.3 years and 72.3% of the patients were male. The triglyceride level was significantly higher in EGC subgroup and BMI was higher in control group (P<0.05). The frequency of overall colorectal polyp was 62.6 % in the EGC group and 54.2% in the control group (p = 0.09). There was no significant difference in number of the polyps per patients between groups. However, the colorectal polyps in patients with EGC were located at right colon more frequently than in the control group(p<0.05). Advanced colorectal neoplasms were found in 10.3% of patients with EGC and 3% of controls (p <0.05). Colorectal cancers were found in 6 patients(4.6%) with EGC . By univariate analysis, patients with advanced colorectal neoplasm in EGC group were older than those with non-advanced neoplasm (66.9±12.4 vs 61.7±10.0, p=0.04). Multivariate analysis showed that the risk factors for advanced colorectal neoplasms in patients with EGC were old age and smoking. Conclusion: Although there was no significant difference in the frequency of overall colorectal polyp, the prevalence of coexisting advanced colorectal neoplasm was higher in patients with EGC than in normal population. Preoperative colonoscopy is strongly indicated in patients with EGC who are old age or smoker The present study showed that colonoscopy