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Fergus V Coakley - One of the best experts on this subject based on the ideXlab platform.

  • evaluation of the biliary intestinal limb of a roux en y choledochojejunostomy using computed tomographic Cholangiography
    Journal of Computer Assisted Tomography, 2008
    Co-Authors: Benjamin M Yeh, Fergus V Coakley, Emily M Webb, Aliya Qayyum, Antonio C Westphalen, Lawrence W Way
    Abstract:

    Computed tomographic (CT) findings involving the biliary intestinal limb of a Roux-en-Y choledochojejunostomy may be ambiguous because oral agents frequently do not reflux into that limb. We describe 2 cases where antegrade biliary intestinal limb opacification by intravenous CT Cholangiography in the left lateral decubitus position obviated the need for biopsy of an apparent enlarging mass in the biliary intestinal limb. We conclude that CT Cholangiography may help clarify the status of a Roux-en-Y choledochojejunostomy.

  • living donor candidates for right hepatic lobe transplantation evaluation at ct Cholangiography initial experience
    Radiology, 2005
    Co-Authors: Zhen J Wang, Benjamin M Yeh, Aliya Qayyum, John P Roberts, Richard S Breiman, Fergus V Coakley
    Abstract:

    PURPOSE: To retrospectively evaluate computed tomographic (CT) Cholangiography in the depiction of second-order biliary tract anatomy in living donor candidates for right hepatic lobe transplantation. MATERIALS AND METHODS: Human research committee approval was obtained, informed consent was not required, and the study was compliant with the Health Insurance Portability and Accountability Act. The authors identified all living right-lobe liver donor candidates who underwent CT Cholangiography at their institution between October 2001 (when CT Cholangiography was introduced at the institution) and March 2003 (n = 62). There were 41 men (mean age, 36 years; range, 18–55 years) and 21 women (mean age, 40 years; range, 22–55 years). Two readers in consensus rated quality of second-order bile duct visualization at CT Cholangiography on a four-point scale (0, not seen; 3, excellent visualization) and noted the presence of variant second-order biliary tract branching anatomy. CT Cholangiography findings were com...

  • biliary tract depiction in living potential liver donors comparison of conventional mr mangafodipir trisodium enhanced excretory mr and multi detector row ct Cholangiography initial experience
    Radiology, 2004
    Co-Authors: Benjamin M Yeh, Aliya Qayyum, John P Roberts, Richard S Breiman, Bachir Taouli, Fergus V Coakley
    Abstract:

    PURPOSE: To compare biliary tract depiction in living potential liver donors at conventional magnetic resonance (MR), mangafodipir trisodium–enhanced excretory MR, and multi–detector row computed tomographic (CT) Cholangiography. MATERIALS AND METHODS: Eight living potential liver donors underwent iodipamide meglumine–enhanced CT Cholangiography. Eight different potential liver donors then underwent conventional MR Cholangiography and mangafodipir trisodium–enhanced excretory MR Cholangiography. Two readers independently scored all first-, second-, and third-order biliary branches with a four-point scale from 0 (not seen) to 3 (excellent visualization). Interobserver agreement was calculated by using the weighted κ statistic. Scores were compared between imaging modalities by using generalized estimating equations. Imaging findings of second-order biliary tract anatomy were compared with intraoperative findings for nine patients. RESULTS: Interobserver agreement for overall biliary tract visualization was...

Jinyoung Choi - One of the best experts on this subject based on the ideXlab platform.

  • preoperative evaluation of bile duct cancer mri combined with mr cholangiopancreatography versus mdct with direct Cholangiography
    American Journal of Roentgenology, 2008
    Co-Authors: Hee Sun Park, Jinyoung Choi, Jeong Min Lee, Min Woo Lee, Hyuk Jung Kim, Joon Koo Han, Byung Ihn Choi
    Abstract:

    OBJECTIVE. The purpose of this study was to compare the performance of MRI combined with MR cholangiopancreatography (MRCP) with that of MDCT combined with direct Cholangiography in the evaluation of the tumor extent and resectability of bile duct cancer with surgical and pathologic findings as the reference standard.MATERIALS AND METHODS. From January 2003 to March 2006, 27 patients (18 men, nine women; mean age, 60.8 years; range, 43–80 years) with surgically proven hilar cholangiocarcinoma or common bile duct (CBD) cancer who had undergone preoperative 2D and 3D MRCP with gadolinium-enhanced MRI and triple-phase MDCT with direct Cholangiography (ERCP or percutaneous transhepatic Cholangiography) were included in this retrospective study. Two experienced radiologists independently reviewed the two image sets. These readers evaluated the longitudinal extent of the tumor for involvement of the secondary confluence of both intrahepatic ducts and the intrapancreatic CBD, vascular involvement of the tumor, l...

  • preoperative evaluation of common bile duct stones in patients with gallstone disease
    American Journal of Roentgenology, 2005
    Co-Authors: Young Jin Kim, Myeongjin Kim, Ki Whang Kim, Jae Book Chung, Woo Jung Lee, Joo Hee Kim, Joon Seok Lim, Jinyoung Choi
    Abstract:

    OBJECTIVE. Our objective was to suggest criteria for selection of a preoperative diagnostic technique for patients with gallstone disease.CONCLUSION. Use of MR Cholangiography preferentially before laparoscopic cholecystectomy, on patients who have a moderate or high risk of common bile duct stones, can significantly reduce purely diagnostic endoscopic retrograde Cholangiography.

R Chuttani - One of the best experts on this subject based on the ideXlab platform.

  • magnetic resonance Cholangiography comparison with endoscopic retrograde cholangiopancreatography
    Gastroenterology, 1996
    Co-Authors: Jorge A Soto, Matthew A Barish, E K Yucel, D Siegenberg, J T Ferrucci, R Chuttani
    Abstract:

    Abstract BACKGROUND & AIMS: Magnetic resonance Cholangiography (MRC) is a noninvasive diagnostic modality capable of producing high-quality images of the biliary tree. The purpose of this study was to determine in a prospective, blinded fashion the sensitivity and specificity of three-dimensional fast spin-echo (3D FSE) MRC for the evaluation of biliary tract abnormalities. METHODS: Forty-six patients referred for elective direct Cholangiography (45 endoscopic retrograde cholangiopancreatography and 1 percutaneous transhepatic Cholangiography) were studied prospectively with 3D FSE MRC during a 1- year period. All images were interpreted blindly by two radiologists. The presence of dilatation, strictures, and intraductal abnormalities was recorded. Sensitivity and specificity of 3D FSE MRC were determined using findings on direct Cholangiography as the gold standard. RESULTS: MRC images of diagnostic quality were obtained in 44 (95.7%) of the patients. Sensitivity for the detection of bile duct dilatation (n = 27), biliary strictures (n = 10), and intraductal abnormalities (n = 7) was 96.3%, 90%, and 100%, respectively. In addition, the MRC showed 16 of 17 patients with normal bile ducts (specificity, 94.1%). CONCLUSIONS: MRC has a very high sensitivity and specificity in the evaluation of the biliary tract. Based on these data, we believe that the efficacy of MRC using 3D FSE is sufficient to warrant its use in the routine diagnosis of biliary tract disease. (Gastroenterology 1996 Feb;110(2):589-97)

Gerald C Osullivan - One of the best experts on this subject based on the ideXlab platform.

  • a prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy natural history of choledocholithiasis revisited
    Annals of Surgery, 2004
    Co-Authors: C Collins, Donal Maguire, Adrian P Ireland, Edward A Fitzgerald, Gerald C Osullivan
    Abstract:

    Although laparoscopic cholecystectomy has been widely adopted as the procedure of choice for gallbladder removal, there is uncertainty about the management of common bile duct calculi in this setting. This is particularly so for those patients where choledocholithiasis is not predicted by preoperative imaging, usually ultrasonography of the biliary tree. In such circumstances many surgeons do not perform routine operative Cholangiography, and clinical experience suggests that the frequency of subsequent symptoms or complications from biliary calculi is low and in the order of 2–3%. This is 30–50% less than that predicted by operative Cholangiography, suggesting overdiagnosis, spontaneous passage, or silent persistence of many common duct calculi. A significant proportion of patients may therefore undergo unnecessary biliary instrumentation with its inherent morbidity and mortality.1–5 Where a confident diagnosis of choledocholithiasis was made, 20–50% patients who underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP) had no demonstrable calculi.6–11 Similarly, almost 20–40% of patients who have bile duct filling defects at per-operative Cholangiography have either a negative surgical bile duct exploration or a negative postoperative ERCP.12–14 Patient selection for biliary intervention has been flawed partly because of the lack of a sensitive noninvasive imaging modality and also because the incidence and natural history of asymptomatic common bile duct calculi has not been determined in patients selected for laparoscopic cholecystectomy. In this study of patients undergoing laparoscopic cholecystectomy, we prospectively define the true incidence of common bile duct calculi and their early natural history by undertaking intraoperative Cholangiography and delayed postoperative Cholangiography in those who had demonstrable intraoperative filling defects in their bile ducts.

Takeaki Ishizawa - One of the best experts on this subject based on the ideXlab platform.

  • application of fluorescent Cholangiography to single incision laparoscopic cholecystectomy
    Surgical Endoscopy and Other Interventional Techniques, 2011
    Co-Authors: Takeaki Ishizawa, Junichi Kaneko, Kiyoshi Hasegawa, Yosuke Inoue, Nobuyuki Takemura, Yasuji Seyama, Taku Aoki, Yoshifumi Beck, Yasuhiko Sugawara, Nobuhiro Harada
    Abstract:

    Although the use of single-incision laparoscopic cholecystectomy (SILC) is spreading rapidly, this technique has disadvantages. It does not allow for sufficient surgical views to be obtained or for intraoperative radiographic Cholangiography to be performed. Fluorescent Cholangiography using a preoperative intravenous injection of indocyanine green (ICG) may be useful for identifying the biliary tract during both SILC and conventional laparoscopic cholecystectomy. For seven patients undergoing SILC, 1 ml of ICG (2.5 mg) was administered by intravenous injection before the surgery. The prototype fluorescent imaging system consisted of a xenon light source and a 30° laparoscope (diameter, 10 mm) equipped with a charge-coupled device camera capable of filtering out light with wavelengths shorter than 810 nm. The laparoscope was introduced through an umbilical trocar. Fluorescent Cholangiography then was performed by changing the color images to fluorescent images using a foot switch during dissection of the triangle of Calot. Fluorescent Cholangiography identified the confluence between the cystic duct and the common hepatic duct in all seven patients before and throughout the dissection of the triangle of Calot. The interval from the injection of ICG to the first obtained fluorescent Cholangiography before dissection of the triangle of Calot ranged from 35 to 75 min. Fluorescent Cholangiography enabled real-time identification of the extrahepatic bile ducts during SILC without necessitating catheterization of the bile duct. Such properties of fluorescent Cholangiography are expected to be helpful for ensuring the safety of SILC and expanding the indications for the procedure.

  • fluorescent Cholangiography illuminating the biliary tree during laparoscopic cholecystectomy
    British Journal of Surgery, 2010
    Co-Authors: Takeaki Ishizawa, Yasutsugu Bandai, Masayoshi Ijichi, Junichi Kaneko, Kiyoshi Hasegawa, Norihiro Kokudo
    Abstract:

    Background: Although intraoperative Cholangiography has been recommended for avoiding bile duct injury during laparoscopic cholecystectomy, radiographic Cholangiography is time consuming and may itself cause injury to the bile duct. Recently, a novel fluorescent Cholangiography technique using the intravenous injection of indocyanine green (ICG) has been developed. Methods: In 52 patients undergoing laparoscopic cholecystectomy, 2·5 mg ICG was injected intravenously 30 min before the patient entered the operating room or following intubation. A fluorescent imaging system, which consisted of a xenon light source and a laparoscope with a charge-coupled device camera that could filter out light wavelengths below 810 nm, was used. Fluorescent Cholangiography was performed during dissection of Calot's triangle, and its ability to delineate biliary anatomy was compared with that of preoperative Cholangiography. Results: Fluorescent Cholangiography delineated the cystic duct in all 52 patients, and the cystic duct–common hepatic duct junction was visible before dissection of Calot's triangle in 50 patients. Fluorescent imaging also identified all accessory bile ducts that had been diagnosed before surgery in eight patients. Conclusion: Fluorescent Cholangiography enables real-time identification of biliary anatomy during dissection of Calot's triangle. This simple technique may become standard practice for avoiding bile duct injury during laparoscopic cholecystectomy, replacing radiographic Cholangiography. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.