Percutaneous-transhepatic-endoscopic rendezvous procedures are effective and safe in patients with refractory bile duct obstruction

Bokemeyer A, Müller F, Niesert H, et al. Percutaneous-transhepatic-endoscopic rendezvous procedures are effective and safe in patients with refractory bile duct obstruction. United European Gastroenterol J. 2019 Apr;7(3):397-404. Free full-text.

New findings:

  • Percutaneous-transhepatic-endoscopic rendezvous procedures (PTE-RVs) offer a high technical success rate (80%) in patients with a previously failed endoscopic retrograde cholangiography, including patients with an altered gastrointestinal tract.
  • Significantly fewer complications occur following PTE-RVs than following percutaneous transhepatic cholangiography (PTC) (16.6 vs 26.6%; p = 0.037); thus, PTE-RVs should be preferred over PTC alone in the case of a necessary percutaneous procedure for biliary interventions.
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Obstructive jaundice and coagulation disturbances

Pavlidis ET, Pavlidis TE. Pathophysiological consequences of obstructive jaundice and perioperative management. Hepatobiliary Pancreat Dis Int. 2018 Feb;17(1):17-21.

Full-text for Emory users.

“Proper management includes full replacement of water and electrolyte deficiency, prophylactic antibiotics, lactulose, vitamin K and fresh frozen plasma, albumin and dopamine. The preoperative biliary drainage has not been indicated in overall, but only in a few selected cases.”

“The coagulation disorders and the resulting hemostasis impairment have been attributed to the complement activation by endotoxin as well as to the reduced synthesis of prothrombin (factor II) in the liver and the other vitamin K depended coagulation factors i.e. VII, IX, X and proteins C, S, Z. The absence of bile salts in the gut prevents the absorption of vitamin K, which is a fat-soluble vitamin. In addition, the endogenous microbial flora produces small amounts of vitamin K. Subsequently the reduced vitamin K absorption results in its deficiency. The latter predisposes to bleeding diathesis, despite the normal laboratory indices such as prothrombin time (PTT) and international normalized ratio (INR). Likewise, the other fat-soluble vitamin D and lipids absorption is diminished resulting in their deficiency and calcium reduction.” (Pavlidis, et al., p. 19.)

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