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Common bile duct dilation after bariatric surgery

机译：牛蒡手术后常见的胆管扩张

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BackgroundBiliary dilation suggests obstruction and prompts further work up. Our experience with endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in the symptomatic post-bariatric surgery population revealed many patients with radiographically dilated bile ducts, but endoscopically normal studies. It is unclear if this finding is phenomenological or an effect of surgery. Additionally, it is unknown whether the type of bariatric surgery alters biliary pathophysiology. Thus, we studied whether a change occurs in biliary diameter following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).MethodsA single-center retrospective study assessing biliary diameter before and after RYGB or SG based on radiographic imaging. All adult patients undergoing RYGB or SG from January 2010 to December 2013 who had imaging studies before and >3months after surgery were included. Those with known obstructive etiologies and those without post-operative imaging were excluded. Common bile duct (CBD) diameter was re-read by a radiologist at the same location in the CBD for pre- and post-operative imaging. Baseline clinical factors and cholecystectomy status were collected.Results269 patients met inclusion criteria (193 RYGB;76 SG). Between the groups, there were no significant differences in pre-operative characteristics. Average time from surgery to repeat imaging was 24.1months. After adjusting for pre-operative factors, subjects who underwent an RYGB had an increase in CBD diameter of 1.4mm (95% CI 0.096, 0.18), which was greater than the change following SG 0.5mm(95% CI -0.007, 0.11). The magnitude of this change did not depend on prior cholecystectomy in the RYGB cohort. Within the SG group, for patients without a prior cholecystectomy, there was a significant increase in post-operative CBD diameter of 0.8mm(95% CI 0.02, 0.14).ConclusionBariatric surgery results in CBD dilation, with changes more pronounced after RYGB. Biliary dilation occurs irrespective of cholecystectomy status. Further work is necessary to determine the cause and clinical implications of this phenomenon.
机译：BackgroundBiliary扩张表明梗阻和提示进一步的工作了。我们与有症状后减肥手术的人群超声内镜和内镜逆行胰胆管造影经验揭示了许多患者的X线扩张胆管，但正常的内镜研究。目前还不清楚这一发现是现象学或手术的效果。此外，目前还不清楚是否减肥手术会改变的类型胆道病理生理学。因此，我们研究是否在以下空肠Roux-en-Y胃旁路术（RYGB）和套筒胃切除术（SG）.MethodsA单中心回顾性研究评估之前和基于放射线照相成像RYGB或SG后胆直径胆道直径发生改变。接受RYGB或SG从2010年1月2013年12月之前，谁和有影像学检查所有成年患者>手术后3个月都包括在内。那些已知阻塞性病因和那些没有手术后的成像被排除在外。胆总管（CBD）直径通过放射科医师在CBD的相同位置前和术后成像再读取。基线临床因素和胆囊切除术状态是collected.Results269患者符合纳入标准（193 RYGB; 76 SG）。各组之间，有在手术前的特性没有显著差异。平均时间从手术到重复成像是24.1个月。调整用于预操作因素后，谁接受的RYGB受试者具有在1.4毫米的CBD直径（95％CI 0.096，0.18），以下SG0.5毫米（95％CI -0.007，0.11），这比变化较大的增加。这种变化的幅度并不依赖于RYGB队列前胆囊切除术。内的SG基团，例无事先胆囊切除术，有在0.8毫米（95％CI 0.02，0.14）.ConclusionBariatric手术导致CBD扩张术后CBD直径的显著增加，RYGB后更为显着的变化。不论发生胆囊切除状态胆道扩张。进一步的工作是必要的，以确定原因和这种现象的临床意义。

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  • 来源
    《Surgical Endoscopy》 |2019年第8期|共8页
  • 作者

    Mehta Neal; Strong Andrew T.; Stevens Tyler; El-Hayek Kevin; Nelson Alfred; Owoyele Adeyinka; Eltelbany Ahmed; Chahal Prabhleen; Rizk Maged; Burke Carol A.; McMichael John; Lopez Rocio; Veniero Joseph; Vargo John; Kroh Matthew; Bhatt Amit;

  • 作者单位

    Cleveland Clin Fdn Med Inst Dept Internal Med 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Dept Gen Surg Digest Dis &

    Surg Inst 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Digest Dis &

    Surg Inst Dept Gastroenterol &

    Hepatol 9500 Euclid Ave;

    Cleveland Clin Fdn Dept Gen Surg Digest Dis &

    Surg Inst 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Med Inst Dept Internal Med 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Imaging Inst Dept Diagnost Radiol 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Med Inst Dept Internal Med 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Digest Dis &

    Surg Inst Dept Gastroenterol &

    Hepatol 9500 Euclid Ave;

    Cleveland Clin Fdn Digest Dis &

    Surg Inst Dept Gastroenterol &

    Hepatol 9500 Euclid Ave;

    Cleveland Clin Fdn Digest Dis &

    Surg Inst Dept Gastroenterol &

    Hepatol 9500 Euclid Ave;

    Cleveland Clin Fdn Dept Gen Surg Digest Dis &

    Surg Inst 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Lerner Res Inst Dept Quantitat Hlth Sci 9500 Euclid Ave Cleveland OH 44195;

    Cleveland Clin Fdn Imaging Inst Dept Diagnost Radiol 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Digest Dis &

    Surg Inst Dept Gastroenterol &

    Hepatol 9500 Euclid Ave;

    Cleveland Clin Fdn Dept Gen Surg Digest Dis &

    Surg Inst 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Digest Dis &

    Surg Inst Dept Gastroenterol &

    Hepatol 9500 Euclid Ave;

  • 收录信息
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 诊断学;
  • 关键词

    Common bile duct dilation; Bariatric surgery; Roux-en-Y gastric bypass; Sleeve gastrectomy; Interventional endoscopy;

    机译：常见的胆管扩张;肥胖手术;Roux-en-Y胃旁路;套筒胃切除术;介入内窥镜检查;

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