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    • "The American Society for Gastrointestinal Endoscopy (ASGE) reported normal liver biochemical test results in more than 97% of 1000 patients undergoing laparoscopic cholecystectomy [24]. The positive predictive value of any abnormal liver biochemical test result by ASGE was 15%; according to other authors it was 25–50% [24–26]. Liver biochemical tests increase progressively with the duration and severity of biliary obstruction. "
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    ABSTRACT: Choledocholithiasis is the most common cause of obstructive jaundice. Common bile duct stones are observed in 10-14% of patients diagnosed with gall bladder stones. In the case of gall bladder and common bile duct stones the procedure involves not only performing cholecystectomy but also removing the stones from bile ducts.
    Full-text · Article · Jun 2014 · Videosurgery and Other Miniinvasive Techniques / Wideochirurgia i Inne Techniki Malo Inwazyjne
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    • "On the other hand, improper selection criteria for ERCP in the setting of suspected CDL may lead to an unnecessary exploration with its own associated risk of morbidity, so identifying the best non-invasive predictors of CDL can also reduce the number of unnecessary procedures. Up to date, there is no clinically validated tool that can be of help in the selection of patients, although there are well made algorithms based on available evidence [5]. We aimed to evaluate serologic biochemical and sonographic (ultrasound) markers of CDL, and to determine which of these markers have the best predictive value in predicting CDL. "
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    ABSTRACT: Prediction of the need for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with suspected choledocholithiasis (CDL) remains a challenging task. We aimed to evaluate the predictive value of biochemical and ultrasound parameters and to create a corresponding model for prediction of the need for therapeutic ERCP. 203 consecutive patients referred to our center due to a firm clinical and/or biochemical suspicion for CDL. All patients underwent ERCP. Biochemical and ultrasound variables were analyzed. The sample was divided into testing group (103; 50.7%) and validation group (100; 49.3%) which did not differ in their baseline characteristics. Elevated gamma glutamil transaminase (GGT), common bile duct (CBD) diameter and presence of hyperechoic structures in CBD were found to be significant predictors for presence of CBD stones on ERCP (p<0.05) in the testing group. We used these variables to construct a predictive model for the presence of CBD stones on ERCP. The model was tested on a second, validation group of patients using ROC analysis with the area under the ROC curve of 0.81 (%95 CI=0.75-0.86; p<0.001). We identified a threshold (0.86) above which, patients had a high probability (93.1%) for the need for interventional ERCP. Our predictive model may help predict the need for therapeutic ERCP in patients with a suspicion for choledocholithiasis.
    Full-text · Article · Dec 2011 · European Journal of Internal Medicine
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    • "On the other hand, improper selection criteria for ERCP in the setting of suspected CDL may lead to an unnecessary exploration with its own associated risk of morbidity, so identifying the best non-invasive predictors of CDL can also reduce the number of unnecessary procedures. Up to date, there is no clinically validated tool that can be of help in the selection of patients, although there are well made algorithms based on available evidence [5]. We aimed to evaluate serologic biochemical and sonographic (ultrasound) markers of CDL, and to determine which of these markers have the best predictive value in predicting CDL. "
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    ABSTRACT: Several authors consider that surgical intervention is the gold standard for treatment of pancreatic abscesses. Recently, considerable interest has been generated in the minimally invasive management of pancreatic abscess with mixed results reported in the literature. To evaluate the efficacy of percutaneous aspiration and/or drainage for patients with pancreatic abscesses. We performed a retrospective analysis of 62 patients with 87 pancreatic abscesses treated by percutaneous management from 1989 to 2009. All patients received appropriate antibiotic therapy. Patients with pancreatic abscess <50mm in diameter were initially treated by ultrasound-guided percutaneous needle aspiration (PNA) and those with abscess ≥50mm were initially treated by ultrasound-guided percutaneous catheter drainage (PCD). Surgery was planned only when there was no clinical improvement after the initial percutaneous treatment. Primary outcome was conversion rate to surgery. Two patients (3.2%) received supportive treatment only and one of them died. PNA was performed in 16 patients (25.8%), and 8 of them required PCD because of recurrence of abscess. In 44 patients (70.1%), PCD was performed initially. PCD was performed twice in 6 patients and 3 times in 2 patients. There were 5 patients converted to surgery (8.1%) and one of them died. Medians (interquartile ranges) of hospital stay and catheter dwell-time were 17 (12-26) and 12 (9-21) days, respectively. There were no complications related to the procedure. Percutaneous aspiration and/or drainage are effective and safe for the treatment of pancreatic abscesses.
    Full-text · Article · Oct 2011 · European Journal of Internal Medicine
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