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Fluid made by the liver and stored in the gallbladder that helps break down fats and get rid of wastes in the body.

Results: 1 to 20 of 77

Endoscopic balloon dilation seems inferior to endoscopic sphincterotomy for common bile duct stone removal

Endoscopic balloon dilation is slightly less successful than endoscopic sphincterotomy in stone extraction and more risky in inducing pancreatitis. However, endoscopic balloon dilation seems to have a clinical role in patients who have a coagulopathy, who are at risk for infection, and possibly in those who are older.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

No evidence to support or refute the effect of bile acids in patients with non‐alcoholic fatty liver disease and/or steatohepatitis

Non‐alcoholic fatty liver disease is a condition characterised by fatty deposition in the hepatocytes in patients with minimal or no alcohol intake. Hepatic injury might be improved by bile acids. This systematic review identified four randomised clinical trials. Bile acids did not cause any liver‐related deaths and were associated with only minor, non‐specific adverse events. However, these agents did not show any significant amelioration of common liver function tests as compared with placebo. Moreover, data on the radiological (ultrasonography and computer tomography scan) and/or histological response were too limited to draw any conclusions. Further randomised placebo‐controlled trials are necessary.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Antibiotics may prevent complications following endoscopy of the bile or pancreatic ductal systems

Endoscopic retrograde cholangiopancreatography (ERCP) involves cannulating the biliary system in order to diagnose bile or pancreatic duct obstruction. It then affords the possibility of relieving this obstruction using various interventions. Traditionally, prophylactic antibiotics have been administered to decrease the incidence of infective complications as a result of interfering with a normally sterile biliary tree. Preventing overuse of antibiotics and consequent bacterial resistance must be aimed. If antibiotics do not prevent complications following ERCP, then antibiotics should not be used.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Bile acids may improve liver biochemistry of patients with hepatitis B or C, but there is insufficient evidence about long‐term beneficial effects

Viral hepatitis causes significant morbidity and mortality. Based on this Cochrane systematic review, bile acids may decrease serum transaminase activities in patients with acute hepatitis B, chronic hepatitis B, or chronic hepatitis C. However, bile acids have no effects in eradicating viral markers. There is insufficient evidence either to support or to refute effects on the long‐term outcomes that include hepatocellular carcinoma, decompensated cirrhosis, and/or liver related mortality.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Prophylactic cholecystectomy should be offered to patients whose gallbladders remain in‐situ after endoscopic sphincterotomy and common bile duct clearance

Surgical removal of the gallbladder is done routinely. Stones in the common bile duct usually come from the gallbladder and can be harmful. The usual treatment for gallstones that are in the common bile duct is endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy. ERCP is an endoscopic procedure to remove stones from the common bile duct. More stones may enter the common bile duct from the gallbladder but it is not clear if the gallbladder should be removed preventively (prophylactic cholecystectomy) or if a wait‐and‐see policy (cholecystectomy deferral) would be better. We included 5 randomised trials with 662 participants out of 93 publications identified through the literature searches. The number of deaths was 47 in the wait‐and‐see group (334 patients) compared with 26 in the prophylactic cholecystectomy group (328 patients). This review of randomised clinical trials suggests that early removal of the gallbladder decreases the risk of death or of complications from gallstones. The number of patients (662) reviewed in this report prevents some of the subgroup analyses from being conclusive. Further clinical trials, particularly of high‐risk patients, would solve this problem.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Bile acids for liver‐transplanted patients

Liver transplantation is a major surgical procedure that has been practiced for more than forty years and has nowadays become a generally accepted treatment option in patients with end‐stage liver disease. The most common cause for liver transplantation in adults is cirrhosis caused by various types of liver injuries such as infections (hepatitis B and C), alcohol, autoimmune liver diseases, early‐stage liver cancer, metabolic and hereditary disorders, but also diseases of unknown aetiology. All transplant recipients need lifetime immunosuppressive therapy to prevent transplant rejection.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Techniques for gaining access to the bile duct for the prevention of post‐procedure pancreatitis

Endoscopic retrograde cholangiopancreatography (ERCP) combines endoscopy and x‐ray to diagnose and treat problems of the bile and pancreatic ducts. With the patient under sedation, an endoscope is passed down the oesophagus, through the stomach, and into the duodenum where the opening of the bile and pancreatic ducts (papilla) is located. A catheter is then inserted through the endoscope and through the papilla into the bile duct. Contrast dye is then injected into the bile duct and x‐rays are taken to look for gallstones or blockage. However, the major risk of ERCP is the development of pancreatitis due to irritation of the pancreatic duct by the contrast material or catheter, which can occur in 5% to 10% of all procedures. This may be self‐limited and mild, but it can also be severe and require hospitalisation. Rarely, it may be life threatening. There are additional small risks of bleeding or making a hole in the bowel wall.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Bile acids for primary sclerosing cholangitis

Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease characterised by progressive inflammation and scarring of liver bile ducts. Destruction of bile ducts leads to incidence of bile flow to the gut, resulting in the development of biliary cirrhosis and end‐stage liver disease. PSC is most common in young males and its aetiology is still not fully understood. The disease is usually classified as an autoimmune disorder, but other aetiological factors cannot be excluded. There is a strong association of PSC with inflammatory bowel diseases, particularly ulcerative colitis, which coexists in approximately 70% of patients. Besides its progressive and irreversible nature, PSC is also associated with an increased risk for cholangiocarcinoma, which contributes to an even higher morbidity and mortality of this disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Biliary drainage before major operations in patients with obstruction of the bile duct

The liver has various functions, including the production and storage of substances necessary for the sustenance of life. It processes toxic substances (including those that are produced within the body because of the breakdown of old red cells) and plays a role in the excretion of these processed toxic substances. It produces bile, which contains substances necessary for the digestion of food. The bile is temporarily stored in the gallbladder and reaches the small bowel via the bile duct, usually in response to a stimulus such as ingestion of fatty food. The processed toxic substances are transported in the bile. These processed toxic substances are eventually excreted when the person opens his or her bowel. When there is obstruction to the flow of bile, the breakdown products of red cells can accumulate and cause yellowish discolouration of the skin and other linings in the body such as the white of the eyeball and the undersurface of the tongue. This results in a form of jaundice called obstructive jaundice. The obstruction to the bile flow is usually caused by stones in the common bile duct. These stones can originate from the gallbladder or from common bile duct stones. The majority of such stones can be treated endoscopically. However, a small proportion of the stones require surgery for removal. Other major causes of biliary obstruction include narrowing of the bile duct resulting from inflammation caused by stones, injury to the bile duct during operations to remove the gallbladder, and cancer of the bile duct, pancreas (an organ situated behind and below the stomach that secretes the digestive juices necessary for the digestion of food in addition to containing the cells that secrete insulin in order to maintain blood sugar levels), or the upper part of the small bowel called the duodenum. Operative removal is currently the only curative treatment available for these cancers. Such operations are typically major operations. However, the presence of toxic substances because of obstruction to the bile flow can result in physiological disturbances. Some surgeons perform certain procedures to temporarily drain the bile before performing the major operation to remove biliary obstruction due to stones, inflammation, or cancer. These pre‐operative procedures can be done endoscopically (by introducing an instrument equipped with a camera through the mouth and into the small intestine and then inserting a small drainage tube through that instrument and past the obstruction in the bile duct) or under X‐ray or other forms of image guidance via the liver. However, other surgeons argue that the temporary procedures to drain the bile are not necessary and that one should perform surgery directly. We sought evidence from randomised clinical trials only regarding this controversy. Such studies, when conducted properly, provide the best evidence. Two authors independently identified the trials and obtained the information from the trials.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

T‐tube drainage versus primary closure after laparoscopic common bile duct exploration

The liver has various functions. Production of bile is one of these functions. Bile is necessary for digestion of fat and removal of certain waste byproducts from the liver. The bile produced in the liver is stored temporarily in the gallbladder. On eating fatty food, the gallbladder releases the bile into the small bowel. The common bile duct is the tube through which bile flows from the gallbladder to the small bowel. Stones can obstruct the flow of bile from the gallbladder into the small bowel. Usually such stones are formed in the gallbladder and migrate into the common bile duct. Obstruction to the flow of bile can lead to jaundice. Such stones are usually removed by inserting an endoscope (introducing an instrument equipped with a camera through the mouth and into the small intestine) before keyhole removal of gallstones (laparoscopic cholecystectomy), or as a part of keyhole removal of gallstones (laparoscopic common bile duct exploration). Laparoscopic common bile duct exploration can only be performed in highly specialised centres and so endoscopic removal of the common bile duct stone is the commonly used method to treat stones in the common bile duct. Laparoscopic common bile duct exploration involves exploring the common bile duct using instruments or a camera, or both, which are introduced into the common bile duct usually through a cut in the common bile duct. After the stones are removed, the hole in the common bile duct has to be stitched. Traditionally, surgeons have used a T‐tube through the cut in the common bile duct but they seal the cystic duct if the exploration is performed through the cystic duct. The T‐tube is shaped like the English letter 'T' as the name indicates. The top part of the letter 'T' is inside the common bile duct while the long bottom part of the 'T' is brought out of the tummy through a small cut and connected to a bag. This tube is inserted with the intention of preventing the build‐up of bile in the common bile duct due to temporary swelling, which is common after any cut in any part of the body. The build‐up of bile along with the swelling can potentially prevent the healing of the bile duct resulting in a leakage of bile from the common bile duct into the tummy. Uncontrolled bile leak can be potentially life‐threatening if this is not recognised and treated appropriately. In addition to acting as a drain, which drains the bile from the common bile duct to the exterior, dye can be injected into the T‐tube and an X‐ray used to demonstrate any residual stones. Once the absence of residual stones is confirmed, the T‐tube is removed. However, surgeons are concerned about the tiny hole which the T‐tube leaves on removal. This tiny hole in the common bile duct normally heals without a trace but, in some patients, bile can leak through this hole and cause the very problem that the T‐tube was meant to prevent. Thus, the use of a T‐tube after laparoscopic common bile duct exploration is a very controversial issue. We have attempted to answer the question whether T‐tube drainage is better than primary closure (stitching the cut in the bile duct without a T‐tube) after laparoscopic exploration of common bile duct by reviewing all the available information from randomised clinical trials that is in the literature. Randomised clinical trials are a special type of clinical study which provides the most accurate answer if performed correctly.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Surgical versus endoscopic treatment of bile duct stones

Gallstones are a common problem in the general population and commonly cause problems with pain (biliary colic) and gallbladder infections (acute cholecystitis). Gallstones can sometimes migrate out of the gallbladder and become trapped in the tube between the gallbladder and the small bowel (common bile duct). Here, they obstruct the flow of bile from the liver and gallbladder into the small bowel and cause pain, jaundice (yellowish discolouration of the eyes, dark urine, and pale stools), and sometimes severe infections of the bile (cholangitis). Between 10% and 18% of people undergoing cholecystectomy for gallstones have common bile duct stones.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

T‐tube drainage versus no T‐tube drainage after open common bile duct exploration

The liver has various functions. Production of bile is one of these functions. Bile is necessary for digestion of fat and removal of certain waste byproducts from the liver. The bile produced in the liver is stored temporarily in the gallbladder. On eating fatty food, the gallbladder releases the bile into the small bowel. The common bile duct is the tube through which bile flows from the liver to the gallbladder, and from there to the small bowel. Stones can obstruct the flow of bile from the gallbladder into the small bowel. Usually such stones are formed in the gallbladder and migrate into the common bile duct. Obstruction of the flow of bile can lead to jaundice. Such stones are usually removed using an endoscope (by introducing an instrument equipped with a camera through the mouth and into the small intestine) before keyhole removal of gallstones (laparoscopic cholecystectomy) or as a part of the keyhole removal of gallstones (laparoscopic common bile duct exploration). Laparoscopic common bile duct exploration can only be performed in highly specialised centres and so endoscopic removal of common bile duct stones is the commonly used method to treat stones in the common bile duct. However, when such endoscopic treatment fails the patient has to be subjected to open common bile duct exploration. This involves exploring the common bile duct using instruments or a camera, or both, which are introduced into the common bile duct usually through a cut in the common bile duct. After the stones are removed, the hole in the common bile duct has to be stitched. Traditionally, surgeons have used a T‐tube through the cut in the common bile duct. The T‐tube is shaped like the English letter 'T' as the name indicates. The top part of the letter 'T' is inside the common bile duct while the long bottom part of the letter 'T' is brought out of the tummy through a small cut and is connected to a bag. This tube is inserted with the intention of preventing the build‐up of bile in the common bile duct due to temporary swelling, which is common after any cut in any part of the body. The build‐up of bile along with the swelling can potentially prevent healing of the bile duct resulting in leakage of bile from the common bile duct into the tummy. Uncontrolled bile leak into the abdominal cavity can be life‐threatening if this is not recognised and treated appropriately. In addition to acting as a drain, draining the bile from the common bile duct to the exterior, dye can be injected into the T‐tube and an X‐ray used to demonstrate any residual stones. Once the absence of residual stones is confirmed, the T‐tube is removed. However, surgeons are concerned about the tiny hole which the T‐tube leaves on removal. This tiny hole in the common bile duct normally heals without a trace, but in some patients bile can leak through the hole and cause the very problem that the T‐tube was meant to prevent. Thus the use of a T‐tube after open common bile duct exploration is a controversial issue. We attempted to answer the question whether primary closure (stitching the cut in the bile duct without a T‐tube) is better than using a T‐tube after open exploration of the common bile duct by reviewing all the available information in the literature from randomised clinical trials. Randomised clinical trials are special types of clinical studies which provide the most valid answers if performed correctly.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Endoscopic retrograde cholangiopancreatography versus intraoperative cholangiography for the diagnosis of common bile duct stones

The liver has various functions. Production of bile is one of these functions. The common bile duct (CBD) is the tube through which bile flows from the gallbladder (where bile is temporarily stored) into the small bowel. Stones in the CBD (CBD stones) can obstruct the flow of bile from the liver into the small bowel. Usually such stones are formed in the gallbladder and migrate into the CBD. Obstruction of the flow of bile can lead to jaundice (yellowish discolouration of skin and white of the eyes, and dark urine), infection of the bile duct (cholangitis), and inflammation of the pancreas (pancreatitis), which can be life threatening. Various diagnostic tests can be performed to diagnose CBD stones. Depending upon the availability of resources, these stones are removed endoscopically (a tube inserted into the stomach and upper part of small bowel through mouth; usually the case), or may be removed as part of the laparoscopic operation (key hole surgery) or open operation performed to remove the gallbladder (cholecystectomy; it is important to remove the gallbladder since the stones continue to form in the gallbladder and can cause recurrent health problems). If the stones are removed endoscopically, presence of stones is confirmed by endoscopic retrograde cholangiopancreatography (ERCP) (injection of dye into the CBD using an endoscope) before endoscopic removal of CBD stones. Alternatively, intraoperative cholangiography (IOC) (injection of dye into the biliary tree during an operation to remove the CBD stones, usually combined with an operation to remove gallstones) can be performed to detect CBD stones prior to operative removal of the stones. We performed a thorough search for studies that reported the accuracy of ERCP or IOC for the diagnosis of CBD stones. The evidence is current to September 2012.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Accessing the bile duct by inserting a guidewire into the pancreatic duct to prevent inflammation of the pancreas after endoscopic retrograde cholangiopancreatography (ERCP)

To compare the effects of the pancreatic duct guidewire (PGW) technique with other endoscopic techniques for gaining access to the bile duct when access to the bile duct is considered to be difficult using traditional techniques.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Ultrasound and liver function tests for the diagnosis of common bile duct stones

Bile, produced in the liver and stored temporarily in the gallbladder, is released into the small bowel on eating fatty food. The common bile duct is the tube through which bile flows from the gallbladder to the small bowel. Stones in the common bile duct (common bile duct stones), usually formed in the gallbladder before migration into the bile duct, can obstruct the flow of bile leading to jaundice (yellowish discolouration of skin, white of the eyes, and dark urine); infection of the bile (cholangitis); and inflammation of the pancreas (pancreatitis), which can be life threatening. Various diagnostic tests can be performed for the diagnosis of common bile duct stones. Depending upon the availability of resources, these stones are removed endoscopically (usually the case) or may be removed as a part of the operation performed to remove the gallbladder (it is important to remove the gallbladder since the stones continue to form in the gallbladder and can cause recurrent problems). Non‐invasive tests such as ultrasound (use of sound waves higher than audible range to differentiate tissues based on how they reflect the sound waves) and blood markers of bile flow obstruction such as serum bilirubin and serum alkaline phosphatase are used to identify people at high risk of having common bile duct stones. Using non‐invasive tests means that only those people at high risk can be subjected to further tests. We reviewed the evidence on the accuracy of ultrasound and liver function tests for detection of common bile duct stones. The evidence is current to September 2012.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Endoscopic ultrasound versus magnetic resonance cholangiopancreatography for the diagnosis of common bile duct stones

Bile, produced in the liver and stored temporarily in the gallbladder, is released into the small bowel on eating fatty food. The common bile duct (CBD) is the tube through which bile flows from the gallbladder to the small bowel. Stones in the CBD (CBD stones) are usually formed in the gallbladder before migration into the bile duct. They can obstruct the flow of bile leading to jaundice (yellowish discolouration of skin, whites of the eyes, and dark urine), infection of the bile (cholangitis), and inflammation of the pancreas (pancreatitis), which can be life threatening. Various diagnostic tests can be performed for the diagnosis of CBD stones. Depending upon the availability of resources, these stones are removed endoscopically (usually the case) or may be removed as part of the operation performed to remove the gallbladder (it is important to remove the gallbladder since the stones continue to form in the gallbladder and can cause recurrent problems). Prior to removal, invasive tests such as endoscopic retrograde cholangiopancreatography (ERCP) or intraoperative cholangiography (IOC) can be performed to detect CBD stones. However, before performing such invasive tests to diagnose CBD stones, non‐invasive tests such as endoscopic ultrasound (EUS) (using ultrasound attached to the endoscope) and magnetic resonance cholangiopancreatography (MRCP) are used to identify people at high risk of having CBD stones so that only those at high risk can be subjected to further tests.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Bile Duct Cancer Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of bile duct cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: July 18, 2016

How does the gallbladder work?

The gallbladder stores and concentrates bile from the liver. The bile then helps to digest and absorb fats from food in the duodenum, the first section of the small intestine.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 7, 2012

Still awaiting evidence for sphincterotomy for biliary sphincter of Oddi dysfunction

Sphincterotomy for biliary sphincter of Oddi dysfunction in patients with a manometrically documented high basal pressure looks attractive, but should not be offered outside new randomised clinical trials.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Routine diversion of food for patients with unresectable periampullary cancers without obstruction to the stomach outlet

Periampullary cancer is cancer that forms near the junction of the lower end of the common bile duct (the channel that transmits bile from the liver to the small bowel), pancreatic duct, and the upper part of the small bowel. Four‐fifths of these tumours are not amenable to surgical removal (unresectable periampullary cancer). Because of its close proximity to the stomach outlet, these periampullary cancers can cause obstruction to the stomach outlet and prevent the flow of food from the stomach to the small bowel. While diversion of food by way of joining the stomach to the upper small bowel (gastrojejunostomy) or inserting a duodenal stent across the obstructed part of the small bowel is necessary for patients who have established stomach outlet obstruction, the role of prophylactic gastrojejunostomy in patients without established stomach outlet obstruction is controversial. The aim of this review was to determine whether prophylactic gastrojejunostomy should be performed routinely in patients with unresectable periampullary cancer. We searched for randomised controlled trials comparing prophylactic gastrojejunostomy versus no gastrojejunostomy in patients with unresectable periampullary cancer. Two review authors independently assessed the studies for inclusion and extracted data.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

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