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Roxana Adelina CIUREZU

Hôpitaux Universitaires de Strasbourg
Strasbourg, France
MD
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Anastomotic biliary stricture after liver transplantation
Biliary stricture is the most frequent complication after liver transplantation, and ranges from 5 to 32%. Biliary strictures in transplanted patients can be anastomotic and non-anastomotic. Endoscopic Retrograde Cholangiopancreatography (ERCP) is the first-line treatment modality for anastomotic biliary strictures and in selected cases of non-anastomotic biliary strictures. Anastomotic biliary strictures arise at the site of the choledocho-choledochostomy. ERCP with multiple plastic stent placements is the first-line treatment of anastomotic biliary strictures, with long-term success rates ranging from 90 to 100%. Also covered self-expandable metal stents can be used for dilation of these strictures, but not routinely.
I Boškoski, RA Ciurezu, I Crisan, L Guerriero, F Habersetzer, M Bouhadjar, D Mutter, J Marescaux
Surgical intervention
1 year ago
1408 views
67 likes
0 comments
09:31
Anastomotic biliary stricture after liver transplantation
Biliary stricture is the most frequent complication after liver transplantation, and ranges from 5 to 32%. Biliary strictures in transplanted patients can be anastomotic and non-anastomotic. Endoscopic Retrograde Cholangiopancreatography (ERCP) is the first-line treatment modality for anastomotic biliary strictures and in selected cases of non-anastomotic biliary strictures. Anastomotic biliary strictures arise at the site of the choledocho-choledochostomy. ERCP with multiple plastic stent placements is the first-line treatment of anastomotic biliary strictures, with long-term success rates ranging from 90 to 100%. Also covered self-expandable metal stents can be used for dilation of these strictures, but not routinely.
Postoperative CBD stenosis
Benign biliary strictures are often a consequence of iatrogenic injury during laparoscopic cholecystectomy or they may arise after liver transplantation or hepatic resection with duct-to-duct biliary anastomosis. Other etiologies of benign biliary strictures are primary sclerosing cholangitis, chronic pancreatitis, and autoimmune cholangitis. In the past, surgical repair was the treatment of choice. Today, ERCP has a pivotal role in the treatment of the vast majority of these lesions. Up to 80% of postoperative benign biliary strictures develop within 6 to 12 months after surgery with symptoms as pruritus, jaundice, abdominal pain, alterations of liver function tests and recurrent cholangitis. Prompt identification of these lesions is essential because long-standing cholestasis can lead to secondary biliary cirrhosis. MRCP with cholangiographic sequences is the preferred non-invasive method for diagnostic cholangiography. In particular, this imaging method can be useful in hilar strictures and in patients with suspected anastomotic biliary stricture after liver transplantation.
I Boškoski, RA Ciurezu, M Morar, L Guerriero, F Habersetzer, M Bouhadjar, D Mutter, J Marescaux
Surgical intervention
1 year ago
963 views
66 likes
0 comments
11:04
Postoperative CBD stenosis
Benign biliary strictures are often a consequence of iatrogenic injury during laparoscopic cholecystectomy or they may arise after liver transplantation or hepatic resection with duct-to-duct biliary anastomosis. Other etiologies of benign biliary strictures are primary sclerosing cholangitis, chronic pancreatitis, and autoimmune cholangitis. In the past, surgical repair was the treatment of choice. Today, ERCP has a pivotal role in the treatment of the vast majority of these lesions. Up to 80% of postoperative benign biliary strictures develop within 6 to 12 months after surgery with symptoms as pruritus, jaundice, abdominal pain, alterations of liver function tests and recurrent cholangitis. Prompt identification of these lesions is essential because long-standing cholestasis can lead to secondary biliary cirrhosis. MRCP with cholangiographic sequences is the preferred non-invasive method for diagnostic cholangiography. In particular, this imaging method can be useful in hilar strictures and in patients with suspected anastomotic biliary stricture after liver transplantation.
ERCP: acute cholangitis in a patient with antiplatelet (clopidogrel) therapy
Acute cholangitis is a clinical emergency. Urgent biliary drainage and bile ducts disobstruction represent the only effective therapy. Acute cholangitis is a result of bile flow obstruction and bile infection. Both ERCP and percutaneous biliary drainage are valid therapeutic options associated with antibiotics. ERCP with biliary sphincterotomy and stones clearance is less invasive and generates less discomfort as compared to percutaneous biliary drainage. Percutaneous biliary drainage is reserved for patients in poor or bad clinical conditions and co-morbidities, unavailability of ERCP or surgically altered anatomy unsuitable for ERCP. We present a case of an 81-year-old female patient with antiplatelet therapy (Plavix®/clopidogrel) and cholangitis. During ERCP, there was evidence of previously unreported small biliary sphincterotomy. Consequently, biliary balloon dilation followed by stones extraction were performed. A nasobiliary drainage was also placed to flush the bile ducts with saline over 24 hours.
I Boškoski, I Crisan, RA Ciurezu, L Guerriero, F Habersetzer, M Bouhadjar, D Mutter, J Marescaux
Surgical intervention
1 year ago
485 views
92 likes
0 comments
09:17
ERCP: acute cholangitis in a patient with antiplatelet (clopidogrel) therapy
Acute cholangitis is a clinical emergency. Urgent biliary drainage and bile ducts disobstruction represent the only effective therapy. Acute cholangitis is a result of bile flow obstruction and bile infection. Both ERCP and percutaneous biliary drainage are valid therapeutic options associated with antibiotics. ERCP with biliary sphincterotomy and stones clearance is less invasive and generates less discomfort as compared to percutaneous biliary drainage. Percutaneous biliary drainage is reserved for patients in poor or bad clinical conditions and co-morbidities, unavailability of ERCP or surgically altered anatomy unsuitable for ERCP. We present a case of an 81-year-old female patient with antiplatelet therapy (Plavix®/clopidogrel) and cholangitis. During ERCP, there was evidence of previously unreported small biliary sphincterotomy. Consequently, biliary balloon dilation followed by stones extraction were performed. A nasobiliary drainage was also placed to flush the bile ducts with saline over 24 hours.
Removal of large biliary stones
Biliary stones can be easy or difficult to remove, depending on their dimensions. Understanding bile ducts anatomy, choosing the appropriate devices/extraction technique, developing confidence with biliary lithotripsy, choosing the appropriate size of the sphincterotomy, performing large balloon biliary dilation in appropriate cases and management of failed stones extraction are the basic key issues in the management of biliary stones. Here, we present the case of a 96-year-old female patient who had an episode of cholangitis one week ago and ERCP was performed with a biliary precut to access the bile duct. Since the biliary stones were large, a biliary plastic stent was placed and after unintentional pancreatic duct cannulation, a pancreatic stent was also placed to prevent pancreatitis. ERCP was repeated. The biliary stent was removed since the stones were approximately 12mm in diameter. A biliary balloon dilation was carried out to facilitate the removal. At the end, the pancreatic stent was also removed.
I Boškoski, M Morar, RA Ciurezu, F Habersetzer, M Bouhadjar, D Mutter, J Marescaux
Surgical intervention
1 year ago
963 views
84 likes
0 comments
12:52
Removal of large biliary stones
Biliary stones can be easy or difficult to remove, depending on their dimensions. Understanding bile ducts anatomy, choosing the appropriate devices/extraction technique, developing confidence with biliary lithotripsy, choosing the appropriate size of the sphincterotomy, performing large balloon biliary dilation in appropriate cases and management of failed stones extraction are the basic key issues in the management of biliary stones. Here, we present the case of a 96-year-old female patient who had an episode of cholangitis one week ago and ERCP was performed with a biliary precut to access the bile duct. Since the biliary stones were large, a biliary plastic stent was placed and after unintentional pancreatic duct cannulation, a pancreatic stent was also placed to prevent pancreatitis. ERCP was repeated. The biliary stent was removed since the stones were approximately 12mm in diameter. A biliary balloon dilation was carried out to facilitate the removal. At the end, the pancreatic stent was also removed.