单人操作导丝法十二指肠乳头插管技术暨外科性胆道梗阻的早期诊断研究
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摘要
第一部分单人操作导丝法十二指肠乳头插管技术研究
目的：
MRCP的出现部分取代了ERCP的诊断功能,ERCP转变为以治疗为主的一种微创外科技术。相应的,其十二指肠乳头插管操作方法也发生了显著变化,由常规的通过造影导管注射对比剂显示胆胰管再进行深插管的造影法插管,转向通过切开刀预置导丝,在导丝引导下插管并造影确认的导丝法插管。而以往导丝法插管需要由助手协助控制导丝才能完成,助手在乳头插管中起着重要的作用,术者和助手的配合对插管的效率及成功率至关重要。新的可快速交换ERCP付件的出现使得单人操作成为可能。单人操作不需要助手的密切配合,有利于缩短插管时间,减少乳头损伤,减少X线暴光时间。本文拟从插管的成功率与并发症的发生率等层面探讨单人操作导丝法进行乳头插管的可行性及优势。
方法：
研究2007年10月到2008年11月和2009年12月到2010年12月约2年多时间在浙江大学附属第一医院肝胆胰外科行ERCP诊疗的病人。病人入选标准：排除乳头切开术后的二次ERCP插管、胃BII式术后ERCP插管及单纯十二指肠镜检查或取支架病人。共有465例连续病人纳入本研究,病人随机分为两组,A组配以熟练水平的助手,B组配以经验欠缺的助手。两组均由同一经验丰富的内镜医生使用单人操作导丝法十二指肠乳头插管技术进行操作。并统计两组病人诊治时十二指肠乳头插管的次数、插管耗时、ERCP术后并发症(如胰腺炎、出血、感染、穿孔)。
结果：
总共465例ERCP病人中460例十二指肠乳头插管成功,成功率为98.98%。总共32例ERCP病人术后出现并发症,并发症发生率为：6.88%,其中胰腺炎、出血、感染、穿孔分别为：5.16%、0.64%、1.08%、0%,按程度分均为轻至中级,无严重并发症或死亡。比较两组之间尝试次数、插管耗时、插管成功率和ERCP恭后并发症,两组之间无显著性差异(P>0.05)。
结论：
单人操作导丝法十二指肠乳头插管技术不需要助手的高度默契配合,可减少对助手的高要求,是一项安全、高效、可行的技术。
第二部分肝内胆管扩张在肝移植术后吻合口狭窄诊治中的应用价值研究
目的：
吻合口狭窄是肝移植术后最常见的胆道并发症和最主要的移植后黄疸原因。区别外科性黄疸和内科性黄疸是合理选择肝移植术后并发症处理方法的关键。肝内胆管扩张是判断外科性胆道梗阻的重要依据。但是,近年来很多报道忽视了肝内胆管扩张在肝移植术后胆道并发症中的作用。他们认为肝移植术后因胆管损伤、肝脏纤维化导致了胆管的顺应性降低,胆管梗阻时肝内胆管往往不易发生扩张,因此根据肝内胆管有否扩张来判断胆道并发症价值不大。作为判断外科性胆道梗阻的重要依据,肝内胆管扩张会否在肝移植术后吻合口狭窄这一胆道梗阻情况中失去应用价值?本研究拟进一步研究并深入探讨肝内胆管扩张在肝移植胆道并发症中的应用价值。
方法：
浙江大学附属第一医院肝胆胰外科自2004年5月至2010年6月,因肝移植术后吻合口狭窄导致黄疸而成功实施ERCP治疗的28例病人入组研究。病人被：分为两组,组A为吻合口狭窄伴肝内胆管扩张(n=22),组B为吻合口狭窄无肝内胆管扩张(n=6)。病人均以总胆红素升高及MRCP影像确诊。两组病人均成功实施ERCP治疗,治疗有气囊扩张狭窄、鼻胆管引流、放置支架等常规方法。我们对比两组病人的治疗效果。
结果：
组A和组B从肝脏移植到发现吻合口狭窄的中位时间分别是38天和434天。组A在ERCP治疗后,总胆红素从142umol/L降至49umol/L (P<0.05).其中14例(63.6%)治愈,8例有效。组B在ERCP治疗后总胆红素无明显改善(P>0.05)。
结论：
肝内胆管扩张是鉴别肝移植后外科性黄疸和非外科性黄疸的关键。治疗性ERCP对吻合口狭窄不伴肝内胆管扩张的病人无效。
第三部分外科胆道梗阻的早期诊断研究
目的：
黄疸是由于胆红素代谢或胆汁排泄障碍,使血清中胆红素含量增高,并造成皮肤、黏膜和巩膜发黄的一系列症状和体征。外科梗阻性黄疸的病因是胆道梗阻,通常包括结石、肿瘤、瘢痕狭窄、炎症水肿、寄生虫等引起的梗阻,需要通过手术或介入等侵入性治疗手段方可缓解。外科胆道梗阻的早期发现仍是目前临床诊疗中的难点问题,解决这一问题有助于肝胆胰疾病的早期诊断与治疗。
方法：
本研究回顾了外科胆道梗阻诊断中的常用实验室检测指标(血清碱性磷酸酶、Y-谷氨酰转肽酶)和影像学检查手段(经皮经肝胆道造影、逆行胆胰管造影、B超、计算机断层扫描、磁共振胆胰管成像等)。着重研究胆道扩张这一影像学发现在胆道梗阻诊断中的作用,并分析了不同的梗阻部位、起病速度和梗阻程度情况下胆管扩张表现的差异。结果:
我们根据无创的MRCP图像将肝内胆管的扩张划分为肝内胆管明显扩张(三级胆管显影,直径大于2mm)、肝内胆管可疑扩张(三级胆管显影,直径小于2mm)、和肝内胆管无扩张(三级胆管未明显影)等三类。我们认为通过MRCP等无创的影像学技术发现肝内胆管扩张是诊断外科胆道梗阻的重要证据,肝内胆管扩张不同于会受到多种因素干扰的肝外胆管扩张,可特异性诊断胆道梗阻,而且肝内胆管扩张的出现时间早于肝脏生化学指标异常,可用于早期诊断胆道梗阻,尤其是慢性不完全性胆道梗阻。通过结合实验室检查,肝内胆管扩张这一影像学征象将有助于及时诊断胆管重建后吻合口狭窄,鉴别内科性黄疸与外科性黄疸和早期发现引起胆道梗阻的肝胆胰等相关肿瘤。
结论：
本研究提出肝内胆管扩张为主的影像学检查联合常规实验室检查可以作为胆道梗阻早期诊断的重要策略,将有助于以梗阻性黄疸为表现的肝胆胰相关疾病的诊断与治疗。
Objective:
With the emerging of MRCP for diagnosing of hepatobiliary pancreatic disorders, ERCP has been diverted mainly to a minimally invasive surgical technique for treatment. Accordingly, the original cannulation technique (probing with a catheter and contrast injection) changed to a wire-guided cannulation (probing with a guidewire). Wire-guided cannulation technique requires one well-trained assistant to manipulate the wire. Excellent communication and precise coordination between the endoscopist and assistant are required, especially for difficult cannulation. The cannulation time and success rate greatly depend on the experience of a well-trained assistant. The single-operator wire-guided cannulation technique become possible until the emergence of rapid exchange system (short guide-wire system). The main objective of this study was to determine the efficiency of single-operator wire-guided cannulation in terms of the number of attempts at cannulation, cannulation time, success rate, and complications. The second objective of this study was to evaluate the role of assistant in this new technique.
Methods:
From October2007to November2008and from December2009to December2010, hospitalized patients with pancreas and biliary diseases referred to the authors for ERCP were recruited into this study. The exclusion criteria were previous endoscopic sphincterotomy, surgically altered anatomy (e.g. Billroth II gastrectomy) or diagnostic duodenoscopy. A total of465consecutive patients were recruited in this prospective study and randomly divided into two groups. A new single-operator wire-guided cannulation technique performed by the same experienced endoscopist, with experienced assistants (Group A) and inexperienced ones (Group B). The number of attempts at cannulation, cannulation time, success rate, and procedure-related complications were recorded.
Results
Successful cannulation was achieved in460out of the465patients (98.92%). The incidences of post-ERCP pancreatitis, bleeding, infection, and perforation were5.16%,0.64%,1.08%, and0%, respectively. There were no severe complications or death. The cannulation time, number of attempts at cannulation and complications were not significantly different between the two groups (all P>0.05).
Conclusions
The single-operator wire-guided cannulation technique doesn't require an experienced assistant and precise coordination between the assistant and endoscopist. It was a safe, efficient and feasible technique.
Part Ⅱ The value of intrahepatic biliary dilation on the diagnosis and treatment of anastomotic stricture with ERCP after orthotopic liver transplantation
Objective:
Anastomotic stricture is the most common biliary complication after liver transplantation and the main cause of obstructive jaundice. Differentiating surgical jaundice from non-surgical one is of vital important after liver transplantation. Intrahepatic biliary dilation is a key point for the diagnosis of surgical biliary obstruction. However, intrahepatic biliary dilation is usually ignored after liver transplantation. It has been reported that biliary injury and liver fibrosis can lead to decreasing of biliary compliance after liver transplantation, making intrahepatic bile duct difficult to dilate when obstruction occuring. Therefore, intrahepatic bilary dilation is considered less valuable for the judgement of biliary complication after liver transplantation. As an important rule to judge surgical biliary obstruction, will intrahepatic biliary dilation lost its diagnosis value in anastomotic stricture after liver transplantation? In this study, we aimed to assess the diagnostic value of intrahepatic biliary dilation in anastomotic stricture after liver transplantation.
Methods:
A total of28jaundice patients were diagnosed as post-transplant anastomotic stricture in the first affiliated hospital, Zhejiang University, school of medicine from May2004to June2010. Twenty-eight patients who underwent sucessful endoscopic retrograde cholangiopancreatography treatments for post-transplant anastomotic stricture were classified into two groups:anastomotic stricture with intrahepatic biliary dilation (Group A, n=22) and anastomotic stricture without intrahepatic biliary dilation (Group B, n=6). The diagnosis of anastomotic stricture was made by elevation of total bilirubin and MRCP. All patients were treated successfully by balloon dilation, nasobiliary drainage, or stent placement. The clinical outcomes of the two groups were evaluated.
Results:
The median time intervals from liver transplantation to the occurrence of anastomotic stricture were38d and434d for Group A and Group B, respectively. The median total bilirubin significantly decreased from142umol/L to49umol/L (P<0.05) two weeks after ERCP treatment in Group A. Fourteen patients (63.6%) was cured and the other8were effective in Group A. But total bilirubin was not improved after the ERCP treatment in Group B (P>0.05).
Conclusions:
Intrahepatic biliary dilation is a key point to differentiate surgical or nonsurgical jaundice. Therapeutic ERCP is not effective in anastomotic stricture without intrahepatic biliary dilation after liver transplantation.
Part III Early Diagnosis of Surgical Biliary Obstruction
Objective:
Jaundice is yellowish pigmentation of the skin, the sclerae and other mucous membranes due to hyperbilirubinemia caused by abnormal bilirubin metabolism and excretion. Surgical obstructive jaundice is caused by biliary obstruction, including calculus, tumor, scar, inflammation or parasite, which needs operation or invasive intervention. Early detection of obstructive jaundice could help diagnosis and treatment of hepatobiliary and pancreatic disorders; however, currently it remains a difficult clinical problem.
Methods
This study reviewed commonly used laboratory tests (alkaline phosphatase and γ-glutamyl transpeptidase) and imaging techniques (percutaneous transhepatic cholangiography, endoscopic retrograde cholangiography, ultrasound, computed tomography and magnetic resonance cholangiopancreatography) for diagnosis of biliary obstruction. We focused on the role of bile duct dilation found by imaging study in diagnosis of biliary obstruction, and further analyzed the manifestation of bile duct dilation under obstruction in varied anatomical location, urgency and severity.
Results
By non-invasive MRCP findings, we defined the dilation of intrahepatic bile duct into three categories:dilation (clearly viewed tertiary bile duct branch, diameter>=2mm), suspicious dilation (clearly viewed tertiary bile duct branch, diameter<2mm) and normal size (no visualization of tertiary bile duct branch). Our finding suggested that intrahepatic bile duct dilation detected by MRCP is important evidence supporting the diagnosis of biliary obstruction. In contrast to extrahepatic bile duct dilation that could be influenced by confounding factors, intrahepatic bile duct dilation has showed its diagnostic specificity. Moreover, it is an earlier sign than liver biochemical abnormality for bile duct obstruction, especially for chronic incomplete bile duct obstruction. Combined with other laboratory tests, image finding of intrahepatic bile duct obstruction could potentially contribute to early diagnosis of postoperative anastomosis stricture of biliary reconstruction, differentiating obstructive and non-obstructive jaundice, and detecting early biliary tumor.
Conclusions
In conclusion, our study suggested that detecting intrahepatic bile duct dilation combined with liver function tests is an important strategy in early identification of biliary obstruction, and it would help the diagnosis and treatment of obstructive hepatobiliary and pancreatic disease.
目的：
MRCP的出现部分取代了ERCP的诊断功能,ERCP转变为以治疗为主的一种微创外科技术。相应的,其十二指肠乳头插管操作方法也发生了显著变化,由常规的通过造影导管注射对比剂显示胆胰管再进行深插管的造影法插管,转向通过切开刀预置导丝,在导丝引导下插管并造影确认的导丝法插管。而以往导丝法插管需要由助手协助控制导丝才能完成,助手在乳头插管中起着重要的作用,术者和助手的配合对插管的效率及成功率至关重要。新的可快速交换ERCP付件的出现使得单人操作成为可能。单人操作不需要助手的密切配合,有利于缩短插管时间,减少乳头损伤,减少X线暴光时间。本文拟从插管的成功率与并发症的发生率等层面探讨单人操作导丝法进行乳头插管的可行性及优势。
方法：
研究2007年10月到2008年11月和2009年12月到2010年12月约2年多时间在浙江大学附属第一医院肝胆胰外科行ERCP诊疗的病人。病人入选标准：排除乳头切开术后的二次ERCP插管、胃BII式术后ERCP插管及单纯十二指肠镜检查或取支架病人。共有465例连续病人纳入本研究,病人随机分为两组,A组配以熟练水平的助手,B组配以经验欠缺的助手。两组均由同一经验丰富的内镜医生使用单人操作导丝法十二指肠乳头插管技术进行操作。并统计两组病人诊治时十二指肠乳头插管的次数、插管耗时、ERCP术后并发症(如胰腺炎、出血、感染、穿孔)。
结果：
总共465例ERCP病人中460例十二指肠乳头插管成功,成功率为98.98%。总共32例ERCP病人术后出现并发症,并发症发生率为：6.88%,其中胰腺炎、出血、感染、穿孔分别为：5.16%、0.64%、1.08%、0%,按程度分均为轻至中级,无严重并发症或死亡。比较两组之间尝试次数、插管耗时、插管成功率和ERCP恭后并发症,两组之间无显著性差异(P>0.05)。
结论：
单人操作导丝法十二指肠乳头插管技术不需要助手的高度默契配合,可减少对助手的高要求,是一项安全、高效、可行的技术。
第二部分肝内胆管扩张在肝移植术后吻合口狭窄诊治中的应用价值研究
目的：
吻合口狭窄是肝移植术后最常见的胆道并发症和最主要的移植后黄疸原因。区别外科性黄疸和内科性黄疸是合理选择肝移植术后并发症处理方法的关键。肝内胆管扩张是判断外科性胆道梗阻的重要依据。但是,近年来很多报道忽视了肝内胆管扩张在肝移植术后胆道并发症中的作用。他们认为肝移植术后因胆管损伤、肝脏纤维化导致了胆管的顺应性降低,胆管梗阻时肝内胆管往往不易发生扩张,因此根据肝内胆管有否扩张来判断胆道并发症价值不大。作为判断外科性胆道梗阻的重要依据,肝内胆管扩张会否在肝移植术后吻合口狭窄这一胆道梗阻情况中失去应用价值?本研究拟进一步研究并深入探讨肝内胆管扩张在肝移植胆道并发症中的应用价值。
方法：
浙江大学附属第一医院肝胆胰外科自2004年5月至2010年6月,因肝移植术后吻合口狭窄导致黄疸而成功实施ERCP治疗的28例病人入组研究。病人被：分为两组,组A为吻合口狭窄伴肝内胆管扩张(n=22),组B为吻合口狭窄无肝内胆管扩张(n=6)。病人均以总胆红素升高及MRCP影像确诊。两组病人均成功实施ERCP治疗,治疗有气囊扩张狭窄、鼻胆管引流、放置支架等常规方法。我们对比两组病人的治疗效果。
结果：
组A和组B从肝脏移植到发现吻合口狭窄的中位时间分别是38天和434天。组A在ERCP治疗后,总胆红素从142umol/L降至49umol/L (P<0.05).其中14例(63.6%)治愈,8例有效。组B在ERCP治疗后总胆红素无明显改善(P>0.05)。
结论：
肝内胆管扩张是鉴别肝移植后外科性黄疸和非外科性黄疸的关键。治疗性ERCP对吻合口狭窄不伴肝内胆管扩张的病人无效。
第三部分外科胆道梗阻的早期诊断研究
目的：
黄疸是由于胆红素代谢或胆汁排泄障碍,使血清中胆红素含量增高,并造成皮肤、黏膜和巩膜发黄的一系列症状和体征。外科梗阻性黄疸的病因是胆道梗阻,通常包括结石、肿瘤、瘢痕狭窄、炎症水肿、寄生虫等引起的梗阻,需要通过手术或介入等侵入性治疗手段方可缓解。外科胆道梗阻的早期发现仍是目前临床诊疗中的难点问题,解决这一问题有助于肝胆胰疾病的早期诊断与治疗。
方法：
本研究回顾了外科胆道梗阻诊断中的常用实验室检测指标(血清碱性磷酸酶、Y-谷氨酰转肽酶)和影像学检查手段(经皮经肝胆道造影、逆行胆胰管造影、B超、计算机断层扫描、磁共振胆胰管成像等)。着重研究胆道扩张这一影像学发现在胆道梗阻诊断中的作用,并分析了不同的梗阻部位、起病速度和梗阻程度情况下胆管扩张表现的差异。结果:
我们根据无创的MRCP图像将肝内胆管的扩张划分为肝内胆管明显扩张(三级胆管显影,直径大于2mm)、肝内胆管可疑扩张(三级胆管显影,直径小于2mm)、和肝内胆管无扩张(三级胆管未明显影)等三类。我们认为通过MRCP等无创的影像学技术发现肝内胆管扩张是诊断外科胆道梗阻的重要证据,肝内胆管扩张不同于会受到多种因素干扰的肝外胆管扩张,可特异性诊断胆道梗阻,而且肝内胆管扩张的出现时间早于肝脏生化学指标异常,可用于早期诊断胆道梗阻,尤其是慢性不完全性胆道梗阻。通过结合实验室检查,肝内胆管扩张这一影像学征象将有助于及时诊断胆管重建后吻合口狭窄,鉴别内科性黄疸与外科性黄疸和早期发现引起胆道梗阻的肝胆胰等相关肿瘤。
结论：
本研究提出肝内胆管扩张为主的影像学检查联合常规实验室检查可以作为胆道梗阻早期诊断的重要策略,将有助于以梗阻性黄疸为表现的肝胆胰相关疾病的诊断与治疗。
Objective:
With the emerging of MRCP for diagnosing of hepatobiliary pancreatic disorders, ERCP has been diverted mainly to a minimally invasive surgical technique for treatment. Accordingly, the original cannulation technique (probing with a catheter and contrast injection) changed to a wire-guided cannulation (probing with a guidewire). Wire-guided cannulation technique requires one well-trained assistant to manipulate the wire. Excellent communication and precise coordination between the endoscopist and assistant are required, especially for difficult cannulation. The cannulation time and success rate greatly depend on the experience of a well-trained assistant. The single-operator wire-guided cannulation technique become possible until the emergence of rapid exchange system (short guide-wire system). The main objective of this study was to determine the efficiency of single-operator wire-guided cannulation in terms of the number of attempts at cannulation, cannulation time, success rate, and complications. The second objective of this study was to evaluate the role of assistant in this new technique.
Methods:
From October2007to November2008and from December2009to December2010, hospitalized patients with pancreas and biliary diseases referred to the authors for ERCP were recruited into this study. The exclusion criteria were previous endoscopic sphincterotomy, surgically altered anatomy (e.g. Billroth II gastrectomy) or diagnostic duodenoscopy. A total of465consecutive patients were recruited in this prospective study and randomly divided into two groups. A new single-operator wire-guided cannulation technique performed by the same experienced endoscopist, with experienced assistants (Group A) and inexperienced ones (Group B). The number of attempts at cannulation, cannulation time, success rate, and procedure-related complications were recorded.
Results
Successful cannulation was achieved in460out of the465patients (98.92%). The incidences of post-ERCP pancreatitis, bleeding, infection, and perforation were5.16%,0.64%,1.08%, and0%, respectively. There were no severe complications or death. The cannulation time, number of attempts at cannulation and complications were not significantly different between the two groups (all P>0.05).
Conclusions
The single-operator wire-guided cannulation technique doesn't require an experienced assistant and precise coordination between the assistant and endoscopist. It was a safe, efficient and feasible technique.
Part Ⅱ The value of intrahepatic biliary dilation on the diagnosis and treatment of anastomotic stricture with ERCP after orthotopic liver transplantation
Objective:
Anastomotic stricture is the most common biliary complication after liver transplantation and the main cause of obstructive jaundice. Differentiating surgical jaundice from non-surgical one is of vital important after liver transplantation. Intrahepatic biliary dilation is a key point for the diagnosis of surgical biliary obstruction. However, intrahepatic biliary dilation is usually ignored after liver transplantation. It has been reported that biliary injury and liver fibrosis can lead to decreasing of biliary compliance after liver transplantation, making intrahepatic bile duct difficult to dilate when obstruction occuring. Therefore, intrahepatic bilary dilation is considered less valuable for the judgement of biliary complication after liver transplantation. As an important rule to judge surgical biliary obstruction, will intrahepatic biliary dilation lost its diagnosis value in anastomotic stricture after liver transplantation? In this study, we aimed to assess the diagnostic value of intrahepatic biliary dilation in anastomotic stricture after liver transplantation.
Methods:
A total of28jaundice patients were diagnosed as post-transplant anastomotic stricture in the first affiliated hospital, Zhejiang University, school of medicine from May2004to June2010. Twenty-eight patients who underwent sucessful endoscopic retrograde cholangiopancreatography treatments for post-transplant anastomotic stricture were classified into two groups:anastomotic stricture with intrahepatic biliary dilation (Group A, n=22) and anastomotic stricture without intrahepatic biliary dilation (Group B, n=6). The diagnosis of anastomotic stricture was made by elevation of total bilirubin and MRCP. All patients were treated successfully by balloon dilation, nasobiliary drainage, or stent placement. The clinical outcomes of the two groups were evaluated.
Results:
The median time intervals from liver transplantation to the occurrence of anastomotic stricture were38d and434d for Group A and Group B, respectively. The median total bilirubin significantly decreased from142umol/L to49umol/L (P<0.05) two weeks after ERCP treatment in Group A. Fourteen patients (63.6%) was cured and the other8were effective in Group A. But total bilirubin was not improved after the ERCP treatment in Group B (P>0.05).
Conclusions:
Intrahepatic biliary dilation is a key point to differentiate surgical or nonsurgical jaundice. Therapeutic ERCP is not effective in anastomotic stricture without intrahepatic biliary dilation after liver transplantation.
Part III Early Diagnosis of Surgical Biliary Obstruction
Objective:
Jaundice is yellowish pigmentation of the skin, the sclerae and other mucous membranes due to hyperbilirubinemia caused by abnormal bilirubin metabolism and excretion. Surgical obstructive jaundice is caused by biliary obstruction, including calculus, tumor, scar, inflammation or parasite, which needs operation or invasive intervention. Early detection of obstructive jaundice could help diagnosis and treatment of hepatobiliary and pancreatic disorders; however, currently it remains a difficult clinical problem.
Methods
This study reviewed commonly used laboratory tests (alkaline phosphatase and γ-glutamyl transpeptidase) and imaging techniques (percutaneous transhepatic cholangiography, endoscopic retrograde cholangiography, ultrasound, computed tomography and magnetic resonance cholangiopancreatography) for diagnosis of biliary obstruction. We focused on the role of bile duct dilation found by imaging study in diagnosis of biliary obstruction, and further analyzed the manifestation of bile duct dilation under obstruction in varied anatomical location, urgency and severity.
Results
By non-invasive MRCP findings, we defined the dilation of intrahepatic bile duct into three categories:dilation (clearly viewed tertiary bile duct branch, diameter>=2mm), suspicious dilation (clearly viewed tertiary bile duct branch, diameter<2mm) and normal size (no visualization of tertiary bile duct branch). Our finding suggested that intrahepatic bile duct dilation detected by MRCP is important evidence supporting the diagnosis of biliary obstruction. In contrast to extrahepatic bile duct dilation that could be influenced by confounding factors, intrahepatic bile duct dilation has showed its diagnostic specificity. Moreover, it is an earlier sign than liver biochemical abnormality for bile duct obstruction, especially for chronic incomplete bile duct obstruction. Combined with other laboratory tests, image finding of intrahepatic bile duct obstruction could potentially contribute to early diagnosis of postoperative anastomosis stricture of biliary reconstruction, differentiating obstructive and non-obstructive jaundice, and detecting early biliary tumor.
Conclusions
In conclusion, our study suggested that detecting intrahepatic bile duct dilation combined with liver function tests is an important strategy in early identification of biliary obstruction, and it would help the diagnosis and treatment of obstructive hepatobiliary and pancreatic disease.
引文
[1]McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of vater:a preliminary report. Ann Surg.1968;167(5):752-6.
[2]Schwacha H, Allgaier HP, Deibert P, Olschewski M, Allgaier U, Blum HE. A sphincterotome-based technique for selective transpapillary common bile duct cannulation. Gastrointest Endosc.2000;52(3):387-91. doi:S0016-5107 (00) 75844-5 [pii] 10.1067/mge.2000.107909
[3]Adler DG, Baron TH, Davila RE, et al. ASGE guideline:the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointestinal Endoscopy. 2005;62(1):1-8. doi:Pii S0016-5107(05)01856-0
[4]Jeurnink SM, Poley JW, Steyerberg EW, Kuipers EJ, Siersema PD. ERCP as an outpatient treatment:a review. Gastrointestinal Endoscopy.2008;68(1): 118-23. doi:DOI 10.1016/j.gie.2007.11.035
[5]Draganov PV, Kowalczyk L, Fazel A, Moezardalan K, Pan JJ, Forsmark CE. Prospective Randomized Blinded Comparison of a Short-Wire Endoscopic Retrograde Cholangiopancreatography System with Traditional Long-Wire Devices. Digest Dis Sci.2010;55(2):510-5. doi:DOI 10.1007/s10620-009-1052-5
[6]Reddy SC, Draganov PV. ERCP wire systems:the long and the short of it. World J Gastroenterol.2009;15(1):55-60.
[7]Lopez A, Ferrer I, Villagrasa RA, et al. A new guidewire cannulation technique in ERCP:successful deep biliary access with triple-lumen sphincterotome and guidewire controlled by the endoscopist. Surg Endosc. 2011;25(6):1876-82. doi:10.1007/s00464-010-1479-y
[1]McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of vater:a preliminary report. Ann Surg.1968;167(5):752-6.
[2]Schwacha H, Allgaier HP, Deibert P, Olschewski M, Allgaier U, Blum HE. A sphincterotome-based technique for selective transpapillary common bile duct cannulation. Gastrointest Endosc.2000;52(3):387-91. doi:S0016-5107 (00) 75844-5 [pii] 10.1067/mge.2000.107909
[3]Adler DG, Baron TH, Davila RE, et al. ASGE guideline:the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointestinal Endoscopy. 2005;62(1):1-8. doi.Pii S0016-5107(05)01856-0
[4]Jeurnink SM, Poley JW, Steyerberg EW, Kuipers EJ, Siersema PD. ERCP as an outpatient treatment:a review. Gastrointestinal Endoscopy.2008;68(1): 118-23. doi:DOI 10.1016/j.gie.2007.11.035
[5]Rabenstein T, Schneider HT, Nicklas M, et al. Impact of skill and experience of the endoscopist on the outcome of endoscopic sphincterotomy techniques. Gastrointestinal Endoscopy.1999;50(5):628-36.
[6]Robison LS, Varadarajulu S, Wilcox CM. Safety and success of precut biliary sphincterotomy:Is it linked to experience or expertise? World Journal of Gastroenterology.2007;13(15):2183-6.
[7]Reddy SC, Draganov PV. ERCP wire systems:the long and the short of it. World J Gastroenterol.2009;15(1):55-60.
[8]Cheon YK, Cho KB, Watkins JL, et al. Frequency and severity of post-ERCP pancreatitis correlated with extent of pancreatic ductal opacification. Gastrointestinal Endoscopy.2007;65(3):385-93. doi:DOI 10.1016/j.gie.2006. 10.021
[9]Lella F, Bagnolo F, Colombo E, Bonassi U. A simple way of avoiding post-ERCP pancreatitis. Gastrointest Endosc.2004;59(7):830-4. doi: S0016510704003633 [pii]
[10]Karamanolis G, Katsikani A, Viazis N, et al. A prospective cross-over study using a sphincterotome and a guidewire to increase the success rate of common bile duct cannulation. World J Gastroenterol.2005; 11(11):1649-52.
[11]Artifon EL, Sakai P, Cunha JE, Halwan B, Ishioka S, Kumar A. Guidewire cannulation reduces risk of post-ERCP pancreatitis and facilitates bile duct cannulation. Am J Gastroenterol.2007; 102(10):2147-53. doi:AJG1378 [pii] 10.1111/j.1572-0241.2007.01378.x
[12]Katsinelos P, Paroutoglou G, Kountouras J, et al. A comparative study of standard ERCP catheter and hydrophilic guide wire in the selective cannulation of the common bile duct. Endoscopy.2008;40(4):302-7. doi:10. 1055/s-2007-995483
[13]Cennamo V, Fuccio L, Zagari RM, et al. Can a Wire-Guided Cannulation Technique Increase Bile Duct Cannulation Rate and Prevent Post-ERCP Pancreatitis?:A Meta-Analysis of Randomized Controlled Trials. American Journal of Gastroenterology.2009;104(9):2343-50. doi:Doi 10.1038/Ajg. 2009.269
[14]Cheung J, Tsoi KK, Quan WL, Lau JYW, Sung JJY. Guidewire versus conventional contrast cannulation of the common bile duct for the prevention of post-ERCP pancreatitis:a systematic review and meta-analysis. Gastrointestinal Endoscopy.2009;70(6):1211-9. doi:DOI 10.1016/j.gie.2009. 08.007
[15]Lee TH, Park DH, Park JY, et al. Can wire-guided cannulation prevent post-ERCP pancreatitis? A prospective randomized trial. Gastrointestinal Endoscopy.2009;69(3):444-9. doi:DOI 10.1016/j.gie.2008.04.064
[16]Mazaki T, Masuda H, Takayama T. Prophylactic pancreatic stent placement and post-ERCP pancreatitis:a systematic review and meta-analysis. Endoscopy.2010;42(10):842-53. doi.DOI 10.1055/s-0030-1255781
[17]Draganov PV, Kowalczyk L, Fazel A, Moezardalan K, Pan JJ, Forsmark CE. Prospective Randomized Blinded Comparison of a Short-Wire Endoscopic Retrograde Cholangiopancreatography System with Traditional Long-Wire Devices. Digest Dis Sci.2010;55(2):510-5. doi:DOI 10.1007/s 10620-009-1052-5
[18]Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med.1996;335(13):909-18.
[19]Lopez A, Ferrer I, Villagrasa RA, et al. A new guidewire cannulation technique in ERCP:successful deep biliary access with triple-lumen sphincterotome and guidewire controlled by the endoscopist. Surg Endosc. 2011;25(6):1876-82. doi:10.1007/s00464-010-1479-y
[20]Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management:an attempt at consensus. Gastrointest Endosc.1991;37(3):383-93.
[21]Cotton PB, Garrow DA, Gallagher J, Romagnuolo J. Risk factors for complications after ERCP:a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc.2009;70(1):80-8. doi:S0016-5107(08)02827-7 [pii] 10.1016/j.gie.2008.10.039
[22]Joyce AM, Ahmad NA, Beilstein MC, et al. Multicenter comparative trial of the V-scope system for therapeutic ERCP. Endoscopy.2006;38(7):713-6. doi:10.1055/s-2006-925446
[23]Huibregtse K. Complications of endoscopic sphincterotomy and their prevention. New Engl J Med.1996;335(13):961-3.
[1]Sharma S, Gurakar A, Camci C, Jabbour N. Avoiding Pitfalls:What an Endoscopist Should Know in Liver Transplantation-Part Ⅱ. Digest Dis Sci. 2009;54(7):1386-402. doi:10.1007/s10620-008-0520-7
[2]Valls C, Alba E, Cruz M, et al. Biliary complications after liver transplantation:diagnosis with MR cholangiopancreatography. AJR Am J Roentgenol.2005; 184(3):812-20. doi:184/3/812 [pii]
[3]Koneru B, Sterling MJ, Bahramipour PF. Bile duct strictures after liver transplantation:A changing landscape of the Achilles'heel. Liver Transplant. 2006;12(5):702-4. doi:Doi 10.1002/Lt.20753
[4]Sharma S, Gurakar A, Jabbour N. Biliary strictures following liver transplantation:past, present and preventive strategies. Liver Transpl.2008; 14(6):759-69. doi:10.1002/lt.21509
[5]Zoepf T, Maldonado-Lopez EJ, Hilgard P, et al. Diagnosis of biliary strictures after liver transplantation:which is the best tool? World J Gastroenterol. 2005; 11(19):2945-8.
[6]Shastri YM, Hoepffner NM, Akoglu B, et al. Liver biochemistry profile, significance and endoscopic management of biliary tract complications post orthotopic liver transplantation. World J Gastroenterol.2007; 13(20):2819-25.
[7]S Peter S, Rodriquez-Davalos MI, Rodriguez-Luna HM, Harrison EM, Moss AA, Mulligan DC. Significance of proximal biliary dilatation in patients with anastomotic strictures after liver transplantation. Dig Dis Sci.2004;49(7-8): 1207-11.
[8]Greif F, Bronsther OL, Van Thiel DH, et al. The incidence, timing, and management of biliary tract complications after orthotopic liver transplantation. Ann Surg.1994;219(1):40-5.
[9]Thuluvath PJ, Atassi T, Lee J. An endoscopic approach to biliary complications following orthotopic liver transplantation. Liver Int.2003; 23(3):156-62.
[10]Verdonk RC, Buis CI, Porte RJ, et al. Anastomotic biliary strictures after liver transplantation:causes and consequences. Liver Transpl.2006;12(5):726-35. doi:10.1002/lt.20714
[11]Morelli J, Mulcahy HE, Willner IR, Cunningham JT, Draganov P. Long-term outcomes for patients with post-liver transplant anastomotic biliary strictures treated by endoscopic stent placement. Gastrointestinal Endoscopy. 2003;58(3):374-9. doi:Pii S0016-5107(03)01722-X
[12]Morelli J, Mulcahy HE, Willner IR, Cunningham JT, Draganov P. Long-term outcomes for patients with post-liver transplant anastomotic biliary strictures treated by endoscopic stent placement. Gastrointest Endosc.2003;58(3): 374-9. doi:S001651070301722X [pii]
[13]Schwartz DA, Petersen BT, Poterucha JJ, Gostout CJ. Endoscopic therapy of anastomotic bile duct strictures occurring after liver transplantation. Gastrointest Endosc.2000;51(2):169-74. doi:S0016510700305855 [pii]
[14]Thethy S, Thomson BNJ, Pleass H, et al. Management of biliary tract complications after orthotopic liver transportation. Clinical Transplantation. 2004;18(6):647-53. doi:DOI 10.1111/j.1399-0012.2004.00254.x
[15]Holt AP, Thorburn D, Mirza D, Gunson B, Wong T, Haydon G. A prospective study of standardized nonsurgical therapy in the management of biliary anastomotic strictures complicating liver transplantation. Transplantation. 2007; 84(7):857-63. doi:DOI 10.1097/01.tp.0000282805.33658.ce
[16]Elmi F, Silverman WB. Outcome of ERCP in the management of duct-to-duct anastomotic strictures in orthotopic liver transplant. Digest Dis Sci.2007; 52(9):2346-50. doi:DOI 10.1007/s10620-006-9142-0
[17]Rossi AF, Grosso C, Zanasi G, et al. Long-term efficacy of endoscopic stenting in patients with stricture of the biliary anastomosis after orthotopic liver transplantation. Endoscopy.1998;30(4):360-6.
[18]Pasha SF, Harrison ME, Das A, et al. Endoscopic treatment of anastomotic biliary strictures after deceased donor liver transplantation:outcomes after maximal stent therapy. Gastrointest Endosc.2007;66(1):44-51. doi:S0016-5107 (07)00277-5 [pii]10.1016/j.gie.2007.02.017
[19]Williams ED, Draganov PV. Endoscopic management of biliary strictures after liver transplantation. World J Gastroenterol.2009;15(30):3725-33.
[20]Fulcher AS, Turner MA. Orthotopic liver transplantation:evaluation with MR cholangiography. Radiology.1999;211(3):715-22.
[21]Ward J, Sheridan MB, Guthrie JA, et al. Bile duct strictures after hepatobiliary surgery:assessment with MR cholangiography. Radiology. 2004;231(1):101-8. doi:10.1148/radiol.23110300172311030017 [pii]
[22]Kok T, Van der Sluis A, Klein JP, et al. Ultrasound and cholangiography for the diagnosis of biliary complications after orthotopic liver transplantation:a comparative study J Clin Ultrasound.1996;24(3):103-15. doi:10.1002/ (SICI)1097-0096(199603)24:3<103::AID-JCU1>3.0.CO;2-L
[23]Londono MC, Balderramo D, Cardenas A. Management of biliary complications after orthotopic liver transplantation:the role of endoscopy. World J Gastroenterol. 2008;14(4):493-7.
[24]Alexopoulos SP, Henningsen JA, Jeffrey RB, Bonham CA, Ahmed A, Gonzalez SA. Management of biliary strictures following liver transplantation. Dig Dis Sci.2009;54(1):25-7. doi:10.1007/s 10620-008-0626-y
[1]Whitfield JB, Pounder RE, Neale G, Moss DW. Serum-glytamyl transpeptidase activity in liver disease. Gut.1972;13(9):702-8.
[2]Weinstein DP, Weinstein BJ, Brodmerkel GJ. Ultrasonography of biliary tract dilatation without jaundice. AJR Am J Roentgenol.1979;132(5):729-34.
[3]Weinstein BJ, Weinstein DP. Biliary tract dilatation in the nonjaundiced patient. AJR Am J Roentgenol.1980;134(5):899-906.
[4]Zeman R, Taylor KJ, Burrell MI, Gold J. Ultrasound demonstration of anicteric dilatation of the biliary tree. Radiology.1980;134(3):689-92.
[5]Beinart C, Efremidis S, Cohen B, Mitty HA. Obstruction without dilation. Importance in evaluating jaundice. JAMA.1981;245(4):353-6.
[6]Zemel G, Zajko AB, Skolnick ML, Bron KM, Campbell WL. The role of sonography and transhepatic cholangiography in the diagnosis of biliary complications after liver transplantation. AJR Am J Roentgenol.1988; 151(5): 943-6.
[7]Muhletaler CA, Gerlock AJ, Jr., Fleischer AC, James AE, Jr. Diagnosis of obstructive jaundice with nondilated bile ducts. AJR Am J Roentgenol. 1980;134(6):1149-52.
[8]Zeman RK, Taylor KJ, Rosenfield AT, Schwartz A, Gold JA. Acute experimental biliary obstruction in the dog:sonographic findings and clinical implications. AJR Am J Roentgenol.1981;136(5):965-7.
[9]Mahour GH, Wakim KG, Ferris DO. The common bile duct in man:its diameter and circumference. Ann Surg.1967;165(3):415-9.
[10]Conrad MR, Landay MJ, Janes JO. Sonographic "parallel channel" sign of biliary tree enlargement in mild to moderate obstructive jaundice. AJR Am J Roentgenol.1978;130(2):279-86.
[11]Taylor KJW, Rosenfield AT. Grey-Scale Ultrasonography in Differential-Diagnosis of Jaundice. Arch Surg-Chicago.1977;112(7):820-5.
[12]Sharma S, Gurakar A, Jabbour N. Biliary strictures following liver transplantation:past, present and preventive strategies. Liver Transpl.2008; 14(6):759-69. doi:10.1002/lt.21509
[13]Shanser JD, Korobkin M, Goldberg HI, Rohlfing BM. Computed tomographic diagnosis of obstructive jaundice in the absence of intrahepatic ductal dilatation. AJR Am J Roentgenol.1978;131(3):389-92.
[14]Kitazono MT, Qayyum A, Yeh BM, Chard PS, Ostroff JW, Coakley FV. Magnetic resonance cholangiography of biliary strictures after liver transplantation:a prospective double-blind study. J Magn Reson Imaging. 2007;25(6):1168-73. doi:10.1002/jmri.20927
[15]Laghi A, Pavone P, Catalano C, et al. MR cholangiography of late biliary complications after liver transplantation. AJR Am J Roentgenol.1999; 172(6):1541-6.
[16]Boraschi P, Braccini G, Gigoni R, et al. Detection of biliary complications after orthotopic liver transplantation with MR cholangiography. Magn Reson Imaging.2001;19(8):1097-105. doi:S0730725X0100443X [pii]
[17]Fulcher AS, Turner MA, Capps GW. MR cholangiography:technical advances and clinical applications. Radiographics.1999;19(1):25-41; discussion-4.
[18]Ward J, Sheridan MB, Guthrie JA, et al. Bile duct strictures after hepatobiliary surgery:assessment with MR cholangiography. Radiology. 2004;231(1):101-8. doi:10.1148/radiol.23110300172311030017 [pii]
[19]Valls C, Alba E, Cruz M, et al. Biliary complications after liver transplantation:diagnosis with MR cholangiopancreatography. AJR Am J Roentgenol.2005;184(3):812-20. doi:184/3/812 [pii]
[20]Conolly WB, Belzer FO, Dunphy JE. Studies in obstructive jaundice. Gut. 1969;10(8):623-7.
[21]Lum G, Gambino SR. Serum gamma-glutamyl transpeptidase activity as an indicator of disease of liver, pancreas, or bone. Clin Chem.1972;18(4):358-62.
[1]McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of vater:a preliminary report. Ann Surg.1968;167(5):752-6.
[2]Adler DG, Baron TH, Davila RE, et al. ASGE guideline:the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointestinal Endoscopy. 2005;62(1):1-8. doi:Pii S0016-5107(05)01856-0
[3]Jeurnink SM, Poley JW, Steyerberg EW, Kuipers EJ, Siersema PD. ERCP as an outpatient treatment:a review. Gastrointestinal Endoscopy.2008;68(1): 118-23. doi:DOI 10.1016/j.gie.2007.11.035
[4]Schwacha H, Allgaier HP, Deibert P, Olschewski M, Allgaier U, Blum HE. A sphincterotome-based technique for selective transpapillary common bile duct cannulation. Gastrointest Endosc.2000;52(3):387-91. doi:S0016- 5107(00)75844-5 [pii] 10.1067/mge.2000.107909
[5]Cheon YK, Cho KB, Watkins JL, et al. Frequency and severity of post-ERCP pancreatitis correlated with extent of pancreatic ductal opacification. Gastrointestinal Endoscopy.2007;65(3):385-93. doi:DOI 10.1016/j.gie.2006. 10.021
[6]Lella F, Bagnolo F, Colombo E, Bonassi U. A simple way of avoiding post-ERCP pancreatitis. Gastrointest Endosc.2004;59(7):830-4. doi: S0016510704003633 [pii]
[7]Karamanolis G, Katsikani A, Viazis N, et al. A prospective cross-over study using a sphincterotome and a guidewire to increase the success rate of common bile duct cannulation. World J Gastroenterol.2005;11(11):1649-52.
[8]Artifon EL, Sakai P, Cunha JE, Halwan B, Ishioka S, Kumar A. Guidewire cannulation reduces risk of post-ERCP pancreatitis and facilitates bile duct cannulation. Am J Gastroenterol.2007;102(10):2147-53. doi:AJG1378 [pii] 10.1111/j.1572-0241.2007.01378.x
[9]Katsinelos P, Paroutoglou G, Kountouras J, et al. A comparative study of standard ERCP catheter and hydrophilic guide wire in the selective cannulation of the common bile duct. Endoscopy.2008;40(4):302-7. doi:10. 1055/S-2007-995483
[10]Cennamo V, Fuccio L, Zagari RM, et al. Can a Wire-Guided Cannulation Technique Increase Bile Duct Cannulation Rate and Prevent Post-ERCP Pancreatitis?:A Meta-Analysis of Randomized Controlled Trials. American Journal of Gastroenterology.2009; 104(9):2343-50. doi:Doi 10.1038/Ajg. 2009.269
[11]Cheung J, Tsoi KK, Quan WL, Lau JYW, Sung JJY. Guidewire versus conventional contrast cannulation of the common bile duct for the prevention of post-ERCP pancreatitis:a systematic review and meta-analysis. Gastrointestinal Endoscopy.2009;70(6):1211-9. doi:DOI 10.1016/j.gie.2009. 08.007
[12]Lee TH, Park DH, Park JY, et al. Can wire-guided cannulation prevent post-ERCP pancreatitis? A prospective randomized trial. Gastrointestinal Endoscopy.2009;69(3):444-9. doi:DOI 10.1016/j.gie.2008.04.064
[13]Mazaki T, Masuda H, Takayama T. Prophylactic pancreatic stent placement and post-ERCP pancreatitis:a systematic review and meta-analysis. Endoscopy.2010;42(10):842-53. doi:DOI 10.1055/s-0030-1255781
[14]Rabenstein T, Schneider HT, Nicklas M, et al. Impact of skill and experience of the endoscopist on the outcome of endoscopic sphincterotomy techniques. Gastrointestinal Endoscopy.1999;50(5):628-36.
[15]Robison LS, Varadarajulu S, Wilcox CM. Safety and success of precut biliary sphincterotomy:Is it linked to experience or expertise? World Journal of Gastroenterology.2007;13(15):2183-6.
[16]Draganov PV, Kowalczyk L, Fazel A, Moezardalan K, Pan JJ, Forsmark CE. Prospective Randomized Blinded Comparison of a Short-Wire Endoscopic Retrograde Cholangiopancreatography System with Traditional Long-Wire Devices. Digest Dis Sci.2010;55(2):510-5. doi:DOI 10.1007/s 10620-009-1052-5
[17]Reddy SC, Draganov PV. ERCP wire systems:the long and the short of it. World J Gastroenterol.2009;15(1):55-60.
[18]Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med.1996;335(13):909-18.
[1]Beinart C, Efremidis S, Cohen B, Mitty HA. Obstruction without dilation. Importance in evaluating jaundice. JAMA.1981;245(4):353-6.
[2]Zeman RK, Taylor KJ, Rosenfield AT, Schwartz A, Gold JA. Acute experimental biliary obstruction in the dog:sonographic findings and clinical implications. AJR Am J Roentgenol.1981;136(5):965-7.
[3]Kok T, Van der Sluis A, Klein JP, et al. Ultrasound and cholangiography for the diagnosis of biliary complications after orthotopic liver transplantation:a comparative study. J Clin Ultrasound.1996;24(3):103-15. doi:10.1002/ (SICI)1097-0096(199603)24:3<103::AID-JCU1>3.0.CO;2-L
[4]Mahour GH, Wakim KG, Ferris DO. The common bile duct in man:its diameter and circumference. Ann Surg.1967;165(3):415-9.
[5]Conrad MR, Landay MJ, Janes JO. Sonographic "parallel channel" sign of biliary tree enlargement in mild to moderate obstructive jaundice. AJR Am J Roentgenol.1978;130(2):279-86.
[6]Taylor KJW, Rosenfield AT. Grey-Scale Ultrasonography in Differential-Diagnosis of Jaundice. Arch Surg-Chicago.1977;112(7):820-5.
[7]Zemel G, Zajko AB, Skolnick ML, Bron KM, Campbell WL. The role of sonography and transhepatic cholangiography in the diagnosis of biliary complications after liver transplantation. AJR Am J Roentgenol.1988;151(5): 943-6.
[8]Sharma S, Gurakar A, Jabbour N. Biliary strictures following liver transplantation:past, present and preventive strategies. Liver Transpl.2008; 14(6):759-69. doi:10.1002/lt.21509
[9]Shanser JD, Korobkin M, Goldberg HI, Rohlfing BM. Computed tomographic diagnosis of obstructive jaundice in the absence of intrahepatic ductal dilatation. AJR Am J Roentgenol.1978;131(3):389-92.
[10]Kitazono MT, Qayyum A, Yeh BM, Chard PS, Ostroff JW, Coakley FV. Magnetic resonance cholangiography of biliary strictures after liver transplantation:a prospective double-blind study. J Magn Reson Imaging. 2007;25(6):1168-73. doi:10.1002/jmri.20927
[11]Laghi A, Pavone P, Catalano C, et al. MR cholangiography of late biliary complications after liver transplantation. AJR Am J Roentgenol.1999; 172(6):1541-6.
[12]Fulcher AS, Turner MA. Orthotopic liver transplantation:evaluation with MR cholangiography. Radiology.1999;211(3):715-22.
[13]Ward J, Sheridan MB, Guthrie JA, et al. Bile duct strictures after hepatobiliary surgery:assessment with MR cholangiography. Radiology. 2004;231(1):101-8. doi:10.1148/radiol.23110300172311030017 [pii]
[14]Boraschi P, Braccini G, Gigoni R, et al. Detection of biliary complications after orthotopic liver transplantation with MR cholangiography. Magn Reson Imaging.2001;19(8):1097-105. doi:S0730725X0100443X [pii]
[15]Valls C, Alba E, Cruz M, et al. Biliary complications after liver transplantation:diagnosis with MR cholangiopancreatography. AJR Am J Roentgenol.2005;184(3):812-20. doi:184/3/812 [pii]
[16]Weinstein DP, Weinstein BJ, Brodmerkel GJ. Ultrasonography of biliary tract dilatation without jaundice. AJR Am J Roentgenol.1979;132(5):729-34.
[17]Muhletaler CA, Gerlock AJ, Jr., Fleischer AC, James AE, Jr. Diagnosis of obstructive jaundice with nondilated bile ducts. AJR Am J Roentgenol.1980; 134(6):1149-52.
[2]Schwacha H, Allgaier HP, Deibert P, Olschewski M, Allgaier U, Blum HE. A sphincterotome-based technique for selective transpapillary common bile duct cannulation. Gastrointest Endosc.2000;52(3):387-91. doi:S0016-5107 (00) 75844-5 [pii] 10.1067/mge.2000.107909
[3]Adler DG, Baron TH, Davila RE, et al. ASGE guideline:the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointestinal Endoscopy. 2005;62(1):1-8. doi:Pii S0016-5107(05)01856-0
[4]Jeurnink SM, Poley JW, Steyerberg EW, Kuipers EJ, Siersema PD. ERCP as an outpatient treatment:a review. Gastrointestinal Endoscopy.2008;68(1): 118-23. doi:DOI 10.1016/j.gie.2007.11.035
[5]Draganov PV, Kowalczyk L, Fazel A, Moezardalan K, Pan JJ, Forsmark CE. Prospective Randomized Blinded Comparison of a Short-Wire Endoscopic Retrograde Cholangiopancreatography System with Traditional Long-Wire Devices. Digest Dis Sci.2010;55(2):510-5. doi:DOI 10.1007/s10620-009-1052-5
[6]Reddy SC, Draganov PV. ERCP wire systems:the long and the short of it. World J Gastroenterol.2009;15(1):55-60.
[7]Lopez A, Ferrer I, Villagrasa RA, et al. A new guidewire cannulation technique in ERCP:successful deep biliary access with triple-lumen sphincterotome and guidewire controlled by the endoscopist. Surg Endosc. 2011;25(6):1876-82. doi:10.1007/s00464-010-1479-y
[1]McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of vater:a preliminary report. Ann Surg.1968;167(5):752-6.
[2]Schwacha H, Allgaier HP, Deibert P, Olschewski M, Allgaier U, Blum HE. A sphincterotome-based technique for selective transpapillary common bile duct cannulation. Gastrointest Endosc.2000;52(3):387-91. doi:S0016-5107 (00) 75844-5 [pii] 10.1067/mge.2000.107909
[3]Adler DG, Baron TH, Davila RE, et al. ASGE guideline:the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointestinal Endoscopy. 2005;62(1):1-8. doi.Pii S0016-5107(05)01856-0
[4]Jeurnink SM, Poley JW, Steyerberg EW, Kuipers EJ, Siersema PD. ERCP as an outpatient treatment:a review. Gastrointestinal Endoscopy.2008;68(1): 118-23. doi:DOI 10.1016/j.gie.2007.11.035
[5]Rabenstein T, Schneider HT, Nicklas M, et al. Impact of skill and experience of the endoscopist on the outcome of endoscopic sphincterotomy techniques. Gastrointestinal Endoscopy.1999;50(5):628-36.
[6]Robison LS, Varadarajulu S, Wilcox CM. Safety and success of precut biliary sphincterotomy:Is it linked to experience or expertise? World Journal of Gastroenterology.2007;13(15):2183-6.
[7]Reddy SC, Draganov PV. ERCP wire systems:the long and the short of it. World J Gastroenterol.2009;15(1):55-60.
[8]Cheon YK, Cho KB, Watkins JL, et al. Frequency and severity of post-ERCP pancreatitis correlated with extent of pancreatic ductal opacification. Gastrointestinal Endoscopy.2007;65(3):385-93. doi:DOI 10.1016/j.gie.2006. 10.021
[9]Lella F, Bagnolo F, Colombo E, Bonassi U. A simple way of avoiding post-ERCP pancreatitis. Gastrointest Endosc.2004;59(7):830-4. doi: S0016510704003633 [pii]
[10]Karamanolis G, Katsikani A, Viazis N, et al. A prospective cross-over study using a sphincterotome and a guidewire to increase the success rate of common bile duct cannulation. World J Gastroenterol.2005; 11(11):1649-52.
[11]Artifon EL, Sakai P, Cunha JE, Halwan B, Ishioka S, Kumar A. Guidewire cannulation reduces risk of post-ERCP pancreatitis and facilitates bile duct cannulation. Am J Gastroenterol.2007; 102(10):2147-53. doi:AJG1378 [pii] 10.1111/j.1572-0241.2007.01378.x
[12]Katsinelos P, Paroutoglou G, Kountouras J, et al. A comparative study of standard ERCP catheter and hydrophilic guide wire in the selective cannulation of the common bile duct. Endoscopy.2008;40(4):302-7. doi:10. 1055/s-2007-995483
[13]Cennamo V, Fuccio L, Zagari RM, et al. Can a Wire-Guided Cannulation Technique Increase Bile Duct Cannulation Rate and Prevent Post-ERCP Pancreatitis?:A Meta-Analysis of Randomized Controlled Trials. American Journal of Gastroenterology.2009;104(9):2343-50. doi:Doi 10.1038/Ajg. 2009.269
[14]Cheung J, Tsoi KK, Quan WL, Lau JYW, Sung JJY. Guidewire versus conventional contrast cannulation of the common bile duct for the prevention of post-ERCP pancreatitis:a systematic review and meta-analysis. Gastrointestinal Endoscopy.2009;70(6):1211-9. doi:DOI 10.1016/j.gie.2009. 08.007
[15]Lee TH, Park DH, Park JY, et al. Can wire-guided cannulation prevent post-ERCP pancreatitis? A prospective randomized trial. Gastrointestinal Endoscopy.2009;69(3):444-9. doi:DOI 10.1016/j.gie.2008.04.064
[16]Mazaki T, Masuda H, Takayama T. Prophylactic pancreatic stent placement and post-ERCP pancreatitis:a systematic review and meta-analysis. Endoscopy.2010;42(10):842-53. doi.DOI 10.1055/s-0030-1255781
[17]Draganov PV, Kowalczyk L, Fazel A, Moezardalan K, Pan JJ, Forsmark CE. Prospective Randomized Blinded Comparison of a Short-Wire Endoscopic Retrograde Cholangiopancreatography System with Traditional Long-Wire Devices. Digest Dis Sci.2010;55(2):510-5. doi:DOI 10.1007/s 10620-009-1052-5
[18]Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med.1996;335(13):909-18.
[19]Lopez A, Ferrer I, Villagrasa RA, et al. A new guidewire cannulation technique in ERCP:successful deep biliary access with triple-lumen sphincterotome and guidewire controlled by the endoscopist. Surg Endosc. 2011;25(6):1876-82. doi:10.1007/s00464-010-1479-y
[20]Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management:an attempt at consensus. Gastrointest Endosc.1991;37(3):383-93.
[21]Cotton PB, Garrow DA, Gallagher J, Romagnuolo J. Risk factors for complications after ERCP:a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc.2009;70(1):80-8. doi:S0016-5107(08)02827-7 [pii] 10.1016/j.gie.2008.10.039
[22]Joyce AM, Ahmad NA, Beilstein MC, et al. Multicenter comparative trial of the V-scope system for therapeutic ERCP. Endoscopy.2006;38(7):713-6. doi:10.1055/s-2006-925446
[23]Huibregtse K. Complications of endoscopic sphincterotomy and their prevention. New Engl J Med.1996;335(13):961-3.
[1]Sharma S, Gurakar A, Camci C, Jabbour N. Avoiding Pitfalls:What an Endoscopist Should Know in Liver Transplantation-Part Ⅱ. Digest Dis Sci. 2009;54(7):1386-402. doi:10.1007/s10620-008-0520-7
[2]Valls C, Alba E, Cruz M, et al. Biliary complications after liver transplantation:diagnosis with MR cholangiopancreatography. AJR Am J Roentgenol.2005; 184(3):812-20. doi:184/3/812 [pii]
[3]Koneru B, Sterling MJ, Bahramipour PF. Bile duct strictures after liver transplantation:A changing landscape of the Achilles'heel. Liver Transplant. 2006;12(5):702-4. doi:Doi 10.1002/Lt.20753
[4]Sharma S, Gurakar A, Jabbour N. Biliary strictures following liver transplantation:past, present and preventive strategies. Liver Transpl.2008; 14(6):759-69. doi:10.1002/lt.21509
[5]Zoepf T, Maldonado-Lopez EJ, Hilgard P, et al. Diagnosis of biliary strictures after liver transplantation:which is the best tool? World J Gastroenterol. 2005; 11(19):2945-8.
[6]Shastri YM, Hoepffner NM, Akoglu B, et al. Liver biochemistry profile, significance and endoscopic management of biliary tract complications post orthotopic liver transplantation. World J Gastroenterol.2007; 13(20):2819-25.
[7]S Peter S, Rodriquez-Davalos MI, Rodriguez-Luna HM, Harrison EM, Moss AA, Mulligan DC. Significance of proximal biliary dilatation in patients with anastomotic strictures after liver transplantation. Dig Dis Sci.2004;49(7-8): 1207-11.
[8]Greif F, Bronsther OL, Van Thiel DH, et al. The incidence, timing, and management of biliary tract complications after orthotopic liver transplantation. Ann Surg.1994;219(1):40-5.
[9]Thuluvath PJ, Atassi T, Lee J. An endoscopic approach to biliary complications following orthotopic liver transplantation. Liver Int.2003; 23(3):156-62.
[10]Verdonk RC, Buis CI, Porte RJ, et al. Anastomotic biliary strictures after liver transplantation:causes and consequences. Liver Transpl.2006;12(5):726-35. doi:10.1002/lt.20714
[11]Morelli J, Mulcahy HE, Willner IR, Cunningham JT, Draganov P. Long-term outcomes for patients with post-liver transplant anastomotic biliary strictures treated by endoscopic stent placement. Gastrointestinal Endoscopy. 2003;58(3):374-9. doi:Pii S0016-5107(03)01722-X
[12]Morelli J, Mulcahy HE, Willner IR, Cunningham JT, Draganov P. Long-term outcomes for patients with post-liver transplant anastomotic biliary strictures treated by endoscopic stent placement. Gastrointest Endosc.2003;58(3): 374-9. doi:S001651070301722X [pii]
[13]Schwartz DA, Petersen BT, Poterucha JJ, Gostout CJ. Endoscopic therapy of anastomotic bile duct strictures occurring after liver transplantation. Gastrointest Endosc.2000;51(2):169-74. doi:S0016510700305855 [pii]
[14]Thethy S, Thomson BNJ, Pleass H, et al. Management of biliary tract complications after orthotopic liver transportation. Clinical Transplantation. 2004;18(6):647-53. doi:DOI 10.1111/j.1399-0012.2004.00254.x
[15]Holt AP, Thorburn D, Mirza D, Gunson B, Wong T, Haydon G. A prospective study of standardized nonsurgical therapy in the management of biliary anastomotic strictures complicating liver transplantation. Transplantation. 2007; 84(7):857-63. doi:DOI 10.1097/01.tp.0000282805.33658.ce
[16]Elmi F, Silverman WB. Outcome of ERCP in the management of duct-to-duct anastomotic strictures in orthotopic liver transplant. Digest Dis Sci.2007; 52(9):2346-50. doi:DOI 10.1007/s10620-006-9142-0
[17]Rossi AF, Grosso C, Zanasi G, et al. Long-term efficacy of endoscopic stenting in patients with stricture of the biliary anastomosis after orthotopic liver transplantation. Endoscopy.1998;30(4):360-6.
[18]Pasha SF, Harrison ME, Das A, et al. Endoscopic treatment of anastomotic biliary strictures after deceased donor liver transplantation:outcomes after maximal stent therapy. Gastrointest Endosc.2007;66(1):44-51. doi:S0016-5107 (07)00277-5 [pii]10.1016/j.gie.2007.02.017
[19]Williams ED, Draganov PV. Endoscopic management of biliary strictures after liver transplantation. World J Gastroenterol.2009;15(30):3725-33.
[20]Fulcher AS, Turner MA. Orthotopic liver transplantation:evaluation with MR cholangiography. Radiology.1999;211(3):715-22.
[21]Ward J, Sheridan MB, Guthrie JA, et al. Bile duct strictures after hepatobiliary surgery:assessment with MR cholangiography. Radiology. 2004;231(1):101-8. doi:10.1148/radiol.23110300172311030017 [pii]
[22]Kok T, Van der Sluis A, Klein JP, et al. Ultrasound and cholangiography for the diagnosis of biliary complications after orthotopic liver transplantation:a comparative study J Clin Ultrasound.1996;24(3):103-15. doi:10.1002/ (SICI)1097-0096(199603)24:3<103::AID-JCU1>3.0.CO;2-L
[23]Londono MC, Balderramo D, Cardenas A. Management of biliary complications after orthotopic liver transplantation:the role of endoscopy. World J Gastroenterol. 2008;14(4):493-7.
[24]Alexopoulos SP, Henningsen JA, Jeffrey RB, Bonham CA, Ahmed A, Gonzalez SA. Management of biliary strictures following liver transplantation. Dig Dis Sci.2009;54(1):25-7. doi:10.1007/s 10620-008-0626-y
[1]Whitfield JB, Pounder RE, Neale G, Moss DW. Serum-glytamyl transpeptidase activity in liver disease. Gut.1972;13(9):702-8.
[2]Weinstein DP, Weinstein BJ, Brodmerkel GJ. Ultrasonography of biliary tract dilatation without jaundice. AJR Am J Roentgenol.1979;132(5):729-34.
[3]Weinstein BJ, Weinstein DP. Biliary tract dilatation in the nonjaundiced patient. AJR Am J Roentgenol.1980;134(5):899-906.
[4]Zeman R, Taylor KJ, Burrell MI, Gold J. Ultrasound demonstration of anicteric dilatation of the biliary tree. Radiology.1980;134(3):689-92.
[5]Beinart C, Efremidis S, Cohen B, Mitty HA. Obstruction without dilation. Importance in evaluating jaundice. JAMA.1981;245(4):353-6.
[6]Zemel G, Zajko AB, Skolnick ML, Bron KM, Campbell WL. The role of sonography and transhepatic cholangiography in the diagnosis of biliary complications after liver transplantation. AJR Am J Roentgenol.1988; 151(5): 943-6.
[7]Muhletaler CA, Gerlock AJ, Jr., Fleischer AC, James AE, Jr. Diagnosis of obstructive jaundice with nondilated bile ducts. AJR Am J Roentgenol. 1980;134(6):1149-52.
[8]Zeman RK, Taylor KJ, Rosenfield AT, Schwartz A, Gold JA. Acute experimental biliary obstruction in the dog:sonographic findings and clinical implications. AJR Am J Roentgenol.1981;136(5):965-7.
[9]Mahour GH, Wakim KG, Ferris DO. The common bile duct in man:its diameter and circumference. Ann Surg.1967;165(3):415-9.
[10]Conrad MR, Landay MJ, Janes JO. Sonographic "parallel channel" sign of biliary tree enlargement in mild to moderate obstructive jaundice. AJR Am J Roentgenol.1978;130(2):279-86.
[11]Taylor KJW, Rosenfield AT. Grey-Scale Ultrasonography in Differential-Diagnosis of Jaundice. Arch Surg-Chicago.1977;112(7):820-5.
[12]Sharma S, Gurakar A, Jabbour N. Biliary strictures following liver transplantation:past, present and preventive strategies. Liver Transpl.2008; 14(6):759-69. doi:10.1002/lt.21509
[13]Shanser JD, Korobkin M, Goldberg HI, Rohlfing BM. Computed tomographic diagnosis of obstructive jaundice in the absence of intrahepatic ductal dilatation. AJR Am J Roentgenol.1978;131(3):389-92.
[14]Kitazono MT, Qayyum A, Yeh BM, Chard PS, Ostroff JW, Coakley FV. Magnetic resonance cholangiography of biliary strictures after liver transplantation:a prospective double-blind study. J Magn Reson Imaging. 2007;25(6):1168-73. doi:10.1002/jmri.20927
[15]Laghi A, Pavone P, Catalano C, et al. MR cholangiography of late biliary complications after liver transplantation. AJR Am J Roentgenol.1999; 172(6):1541-6.
[16]Boraschi P, Braccini G, Gigoni R, et al. Detection of biliary complications after orthotopic liver transplantation with MR cholangiography. Magn Reson Imaging.2001;19(8):1097-105. doi:S0730725X0100443X [pii]
[17]Fulcher AS, Turner MA, Capps GW. MR cholangiography:technical advances and clinical applications. Radiographics.1999;19(1):25-41; discussion-4.
[18]Ward J, Sheridan MB, Guthrie JA, et al. Bile duct strictures after hepatobiliary surgery:assessment with MR cholangiography. Radiology. 2004;231(1):101-8. doi:10.1148/radiol.23110300172311030017 [pii]
[19]Valls C, Alba E, Cruz M, et al. Biliary complications after liver transplantation:diagnosis with MR cholangiopancreatography. AJR Am J Roentgenol.2005;184(3):812-20. doi:184/3/812 [pii]
[20]Conolly WB, Belzer FO, Dunphy JE. Studies in obstructive jaundice. Gut. 1969;10(8):623-7.
[21]Lum G, Gambino SR. Serum gamma-glutamyl transpeptidase activity as an indicator of disease of liver, pancreas, or bone. Clin Chem.1972;18(4):358-62.
[1]McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of vater:a preliminary report. Ann Surg.1968;167(5):752-6.
[2]Adler DG, Baron TH, Davila RE, et al. ASGE guideline:the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointestinal Endoscopy. 2005;62(1):1-8. doi:Pii S0016-5107(05)01856-0
[3]Jeurnink SM, Poley JW, Steyerberg EW, Kuipers EJ, Siersema PD. ERCP as an outpatient treatment:a review. Gastrointestinal Endoscopy.2008;68(1): 118-23. doi:DOI 10.1016/j.gie.2007.11.035
[4]Schwacha H, Allgaier HP, Deibert P, Olschewski M, Allgaier U, Blum HE. A sphincterotome-based technique for selective transpapillary common bile duct cannulation. Gastrointest Endosc.2000;52(3):387-91. doi:S0016- 5107(00)75844-5 [pii] 10.1067/mge.2000.107909
[5]Cheon YK, Cho KB, Watkins JL, et al. Frequency and severity of post-ERCP pancreatitis correlated with extent of pancreatic ductal opacification. Gastrointestinal Endoscopy.2007;65(3):385-93. doi:DOI 10.1016/j.gie.2006. 10.021
[6]Lella F, Bagnolo F, Colombo E, Bonassi U. A simple way of avoiding post-ERCP pancreatitis. Gastrointest Endosc.2004;59(7):830-4. doi: S0016510704003633 [pii]
[7]Karamanolis G, Katsikani A, Viazis N, et al. A prospective cross-over study using a sphincterotome and a guidewire to increase the success rate of common bile duct cannulation. World J Gastroenterol.2005;11(11):1649-52.
[8]Artifon EL, Sakai P, Cunha JE, Halwan B, Ishioka S, Kumar A. Guidewire cannulation reduces risk of post-ERCP pancreatitis and facilitates bile duct cannulation. Am J Gastroenterol.2007;102(10):2147-53. doi:AJG1378 [pii] 10.1111/j.1572-0241.2007.01378.x
[9]Katsinelos P, Paroutoglou G, Kountouras J, et al. A comparative study of standard ERCP catheter and hydrophilic guide wire in the selective cannulation of the common bile duct. Endoscopy.2008;40(4):302-7. doi:10. 1055/S-2007-995483
[10]Cennamo V, Fuccio L, Zagari RM, et al. Can a Wire-Guided Cannulation Technique Increase Bile Duct Cannulation Rate and Prevent Post-ERCP Pancreatitis?:A Meta-Analysis of Randomized Controlled Trials. American Journal of Gastroenterology.2009; 104(9):2343-50. doi:Doi 10.1038/Ajg. 2009.269
[11]Cheung J, Tsoi KK, Quan WL, Lau JYW, Sung JJY. Guidewire versus conventional contrast cannulation of the common bile duct for the prevention of post-ERCP pancreatitis:a systematic review and meta-analysis. Gastrointestinal Endoscopy.2009;70(6):1211-9. doi:DOI 10.1016/j.gie.2009. 08.007
[12]Lee TH, Park DH, Park JY, et al. Can wire-guided cannulation prevent post-ERCP pancreatitis? A prospective randomized trial. Gastrointestinal Endoscopy.2009;69(3):444-9. doi:DOI 10.1016/j.gie.2008.04.064
[13]Mazaki T, Masuda H, Takayama T. Prophylactic pancreatic stent placement and post-ERCP pancreatitis:a systematic review and meta-analysis. Endoscopy.2010;42(10):842-53. doi:DOI 10.1055/s-0030-1255781
[14]Rabenstein T, Schneider HT, Nicklas M, et al. Impact of skill and experience of the endoscopist on the outcome of endoscopic sphincterotomy techniques. Gastrointestinal Endoscopy.1999;50(5):628-36.
[15]Robison LS, Varadarajulu S, Wilcox CM. Safety and success of precut biliary sphincterotomy:Is it linked to experience or expertise? World Journal of Gastroenterology.2007;13(15):2183-6.
[16]Draganov PV, Kowalczyk L, Fazel A, Moezardalan K, Pan JJ, Forsmark CE. Prospective Randomized Blinded Comparison of a Short-Wire Endoscopic Retrograde Cholangiopancreatography System with Traditional Long-Wire Devices. Digest Dis Sci.2010;55(2):510-5. doi:DOI 10.1007/s 10620-009-1052-5
[17]Reddy SC, Draganov PV. ERCP wire systems:the long and the short of it. World J Gastroenterol.2009;15(1):55-60.
[18]Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med.1996;335(13):909-18.
[1]Beinart C, Efremidis S, Cohen B, Mitty HA. Obstruction without dilation. Importance in evaluating jaundice. JAMA.1981;245(4):353-6.
[2]Zeman RK, Taylor KJ, Rosenfield AT, Schwartz A, Gold JA. Acute experimental biliary obstruction in the dog:sonographic findings and clinical implications. AJR Am J Roentgenol.1981;136(5):965-7.
[3]Kok T, Van der Sluis A, Klein JP, et al. Ultrasound and cholangiography for the diagnosis of biliary complications after orthotopic liver transplantation:a comparative study. J Clin Ultrasound.1996;24(3):103-15. doi:10.1002/ (SICI)1097-0096(199603)24:3<103::AID-JCU1>3.0.CO;2-L
[4]Mahour GH, Wakim KG, Ferris DO. The common bile duct in man:its diameter and circumference. Ann Surg.1967;165(3):415-9.
[5]Conrad MR, Landay MJ, Janes JO. Sonographic "parallel channel" sign of biliary tree enlargement in mild to moderate obstructive jaundice. AJR Am J Roentgenol.1978;130(2):279-86.
[6]Taylor KJW, Rosenfield AT. Grey-Scale Ultrasonography in Differential-Diagnosis of Jaundice. Arch Surg-Chicago.1977;112(7):820-5.
[7]Zemel G, Zajko AB, Skolnick ML, Bron KM, Campbell WL. The role of sonography and transhepatic cholangiography in the diagnosis of biliary complications after liver transplantation. AJR Am J Roentgenol.1988;151(5): 943-6.
[8]Sharma S, Gurakar A, Jabbour N. Biliary strictures following liver transplantation:past, present and preventive strategies. Liver Transpl.2008; 14(6):759-69. doi:10.1002/lt.21509
[9]Shanser JD, Korobkin M, Goldberg HI, Rohlfing BM. Computed tomographic diagnosis of obstructive jaundice in the absence of intrahepatic ductal dilatation. AJR Am J Roentgenol.1978;131(3):389-92.
[10]Kitazono MT, Qayyum A, Yeh BM, Chard PS, Ostroff JW, Coakley FV. Magnetic resonance cholangiography of biliary strictures after liver transplantation:a prospective double-blind study. J Magn Reson Imaging. 2007;25(6):1168-73. doi:10.1002/jmri.20927
[11]Laghi A, Pavone P, Catalano C, et al. MR cholangiography of late biliary complications after liver transplantation. AJR Am J Roentgenol.1999; 172(6):1541-6.
[12]Fulcher AS, Turner MA. Orthotopic liver transplantation:evaluation with MR cholangiography. Radiology.1999;211(3):715-22.
[13]Ward J, Sheridan MB, Guthrie JA, et al. Bile duct strictures after hepatobiliary surgery:assessment with MR cholangiography. Radiology. 2004;231(1):101-8. doi:10.1148/radiol.23110300172311030017 [pii]
[14]Boraschi P, Braccini G, Gigoni R, et al. Detection of biliary complications after orthotopic liver transplantation with MR cholangiography. Magn Reson Imaging.2001;19(8):1097-105. doi:S0730725X0100443X [pii]
[15]Valls C, Alba E, Cruz M, et al. Biliary complications after liver transplantation:diagnosis with MR cholangiopancreatography. AJR Am J Roentgenol.2005;184(3):812-20. doi:184/3/812 [pii]
[16]Weinstein DP, Weinstein BJ, Brodmerkel GJ. Ultrasonography of biliary tract dilatation without jaundice. AJR Am J Roentgenol.1979;132(5):729-34.
[17]Muhletaler CA, Gerlock AJ, Jr., Fleischer AC, James AE, Jr. Diagnosis of obstructive jaundice with nondilated bile ducts. AJR Am J Roentgenol.1980; 134(6):1149-52.