A modern approach in the complex treatment of patients with choledocholithiasis against the background of liver cirrhosis | Український Медичний Часопис

Purpose: to investigate the effectiveness of a complex approach in the treatment of patients with choledocholithiasis complicated by concomitant liver cirrhosis.

Object and research methods. A prospective analysis of the treatment of 37 patients with choledocholithiasis with accompanying liver cirrhosis, who were treated in the Kyiv City Clinical Hospital of Emergency Care from 2019 to 2023, was conducted. The scope of medical care, the course and effectiveness of the treatment were characterized.

The results. According to the results of a prospective analysis of the treatment of patients with choledocholithiasis complicated by concomitant liver cirrhosis, it was found that the applied complex therapeutic algorithm contributed to the improvement of the general condition of patients, the reduction of dyspeptic manifestations, astheno-vegetative disorders and the severity of pain syndrome, the resolution of the symptoms of mechanical jaundice, the normalization of laboratory and biochemical indicators, stabilization of blood coagulation profile. Improvement of the synthetic and detoxification function of the liver, normalization of hepatic hemodynamics and activation of regenerative processes were noted.

Conclusion. The use of a complex interdisciplinary approach in the treatment of choledocholithiasis against the background of liver cirrhosis reveals a positive effect on the clinical and biochemical indicators of the course of the disease with positive dynamics of the resolution of the symptomatic picture of both the main and accompanying pathology, which indicates the effectiveness of the selected approach and the optimality of its integration into standardized algorithms of targeted treatment of patients with choledocholithiasis, complicated liver cirrhosis.

References

1. Shaffer E.A. (2006) Gallstone disease: Epidemiology of gallbladder stone disease. Best Pract. Res. Clin. Gastroenterol., 20(6): 981–996. doi: 10.1016/j.bpg.2006.05.004.
2. Tazuma S. (2006) Gallstone disease: Epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic). Best Pract. Res. Clin. Gastroenterol., 20(6): 1075–1083. doi: 10.1016/j.bpg.2006.05.009.
3. Li S., Guizzetti L., Ma C. et al. (2023) Epidemiology and outcomes of choledocholithiasis and cholangitis in the United States: trends and urban-rural variations. BMC Gastroenterol., 23(1): 254. doi: 10.1186/s12876-023-02868-3.
4. Møller S., Henriksen J.H., Bendtsen F. (2014) Extrahepatic complications to cirrhosis and portal hypertension: haemodynamic and homeostatic aspects. World J. Gastroenterol., 20(42): 15499–15517. doi.org/10.3748/wjg.v20.i42.15499.
5. Møller S., Bendtsen F. (2015) Complications of cirrhosis. A 50 years flashback. Scandinavian J. Gastroenterol., 50(6): 763–780.
6. Perez Ruiz de Garibay A., Kortgen A., Leonhardt J. et al. (2022) Critical care hepatology: definitions, incidence, prognosis and role of liver failure in critically ill patients. Critical care (London, England), 26(1): 289.
7. Møller S., Bendtsen F. (2015) Cirrhotic Multiorgan Syndrome. Digestive diseases and sciences, 60(11): 3209–3225. doi.org/10.1007/s10620-015-3752-3.
8. Kaltenbach M.G., Mahmud N. (2023) Assessing the risk of surgery in patients with cirrhosis. Hepatol. Communicat., 7(4): e0086.
9. Wong M., Busuttil R.W. (2019) Surgery in Patients with Portal Hypertension. Clinics in liver disease, 23(4): 755–780. doi.org/10.1016/j.cld.2019.07.003.
10. Hackl C., Schlitt H.J., Renner P., Lang S.A. (2016) Liver surgery in cirrhosis and portal hypertension. World J. Gastroenterol., 22(9): 2725–2735.
11. Abbas N., Fallowfield J., Patch D. et al. (2023) Guidance document: risk assessment of patients with cirrhosis prior to elective non-hepatic surgery. Frontl. Gastroenterol., 14(5): 359–370.
12. Ostojic A., Mahmud N., Reddy K.R. (2024) Surgical risk stratification in patients with cirrhosis. Hepatol. International., 18(3): 876–891.
13. Ng Z.Q., Tan P., Theophilus M. (2023) Colorectal Surgery in Patients with Liver Cirrhosis: A Systematic Review. World J. Surg., 47(10): 2519–2531.
14. Martin Mateos R., Garcia de la Filia Molina I., Albillos A. (2020) Pre-surgical risk assessment in patients with cirrhosis. Acta gastro-enterologica Belgica, 83(3): 449–453.
15. Solanki S., Kichloo A., Dahiya D.S. et al. (2022) Endoscopic Retrograde Cholangiopancreatography (ERCP) in Patients With Liver Cirrhosis: Analysis of Trends and Outcomes From the National Inpatient Sample Database. J. Clin. Gastroenterol., 56(7): 618–626.
16. Navaneethan U., Njei B., Zhu X. et al. (2017) Safety of ERCP in patients with liver cirrhosis: a national database study. Endoscopy international open, 5(4): E303–E314.
17. Shah T., Tapper E.B. (2019) ERCP in Patients With Cirrhosis: «Risky Business« Or «Just Do it«? Am. J. Gastroenterol., 114(1): 19–20.
18. Maksymenko M., Susak Y., Korotia M. et al. (2024) Standards for providing emergency care at the prehospital and early hospital stages for patients with mechanical jaundice. Emerg. Med., 20(2): 137–143.
19. Ge P.S., Runyon B.A. (2016) Treatment of Patients with Cirrhosis. New Engl. J. Med., 375(8): 767–777. doi.org/10.1056/NEJMra1504367.
20. Perricone G., Artzner T., De Martin E. et al. (2023) Intensive care management of acute-on-chronic liver failure. Intens. Care Med., 49(8): 903–921.
21. Leal C., Prado V., Colan J. et al. (2019) Adverse Events and Acute Chronic Liver Failure in Patients With Cirrhosis Undergoing Endoscopic Retrograde Cholangiopancreatography: A Multicenter Matched-Cohort Study. Am. J. Gastroenterol., 114(1): 89–97.
22. Rizzo A., Ricci A.D., Frega G. et al. (2020) How to Choose Between Percutaneous Transhepatic and Endoscopic Biliary Drainage in Malignant Obstructive Jaundice: An Updated Systematic Review and Meta-analysis. In vivo (Athens, Greece), 34(4): 1701–1714.
23. Liu J.G., Wu J., Wang J. et al. (2018) Endoscopic Biliary Drainage Versus Percutaneous Transhepatic Biliary Drainage in Patients with Resectable Hilar Cholangiocarcinoma: A Systematic Review and Meta-Analysis. J. Laparoendosc. Adv. Surg. Techniq., 28(9): 1053–1060.
24. Hassan Z., Gadour E. (2022) Percutaneous transhepatic cholangiography vs endoscopic ultrasound-guided biliary drainage: A systematic review. World J. Gastroenterol., 28(27): 3514–3523. doi.org/10.3748/wjg.v28.i27.3514.
25. Castera L., Forns X., Alberti A. (2008) Non-invasive evaluation of liver fibrosis using transient elastography. J. Hepatol., 48(5): 835–847.
26. Björnsson E.S. (2015) Liver injury associated with the analgetic drug metamizole. Br J Clin Pharmacol., 86(7): 1248–1250. doi: 10.1111/bcp.14294.
27. Thompson D.R. (2001) Narcotic Analgesic Effects on The Sphincter of Oddi: A Review of The Data and Therapeutic Implications in Treating Pancreatitis. Am. J. Gastroenterol., 96(4): 1266–1272. doi: 10.1111/j.1572-0241.2001.03536.x.
28. Lacy B.E., Cangemi D., Vazquez-Roque M. (2021) Management of Chronic Abdominal Distension and Bloating. Clin. Gastroenterol. Hepatol., 19(2): 219–231.
29. Treinen C., Lomelin D., Krause C. et al. (2015) Acute acalculous cholecystitis in the critically ill: risk factors and surgical strategies. Langenbecks Arch. Surg., 400(4): 421–427.
30. Thabit A.K. (2020) Antibiotics in the Biliary Tract: A Review of the Pharmacokinetics and Clinical Outcomes of Antibiotics Penetrating the Bile and Gallbladder Wall. Pharmacotherapy, 40(7): 672–691. doi.org/10.1002/phar.2431.
31. Nykula T.D., Moiseienko V.O., Manzhalii E.H. (2016) The experience of using parenteral nutrition in the treatment of liver insufficiency. Gastroenterol., 1(2016): 53–57.
32. Levi M., Toh C.H., Thachil J., Watson H.G. (2009) Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br. J. Haematol., 145(1): 24–33.
33. Udut V.V., Vengerovsky A.I., Dygai A.M. (2013) Effects of phospholipid hepatoprotectors on apoptosis during experimental liver pathology induced by isoniazid and paracetamol. Bull. Exp. Biol. Med., 154(5): 614–617.
34. de la Riva G.A., López Mendoza F.J., Agüero-Chapin G. (2018) Known Hepatoprotectors Act as Antioxidants and Immune Stimulators in Stressed Mice: Perspectives in Animal Health Care. Curr. Pharm. Des., 24(40): 4825–4837.
35. Trebicka J., Macnaughtan J., Schnabl B. et al. (2021) The microbiota in cirrhosis and its role in hepatic decompensation. J Hepatol., 75 Suppl. 1(Suppl 1): S67–S81.
36. Gvozdenko T.A., Ian’kova V.I. (2003) Deĭstvie énterosorbentov prirodnogo proiskhozhdeniia pri éksperimental’noĭ patologii pochek. Eksp. Klin. Farmakol., 66(4): 60–62.
37. Rudler M., Mallet M., Sultanik P. et al. (2020) Optimal management of ascites. Liver Int., 40 Suppl. 1: 128–135. doi: 10.1111/liv.14361.
38. Hou W., Sanyal A.J. (2009) Ascites: diagnosis and management. Med. Clin. North Am., 93(4): 801–817.
39. Arroyo V., Ginès P., Planas R. (1992) Treatment of ascites in cirrhosis. Diuretics, peritoneovenous shunt, and large-volume paracentesis. Gastroenterol. Clin. North Am., 21(1): 237–256.
40. Chuklin S., Chuklin S. (2020) Vitamin C in critical conditions: from bench to bedside (part 1). Emerg. med., 16(7–8): 118–125.
41. Thawley V. (2017) Acute Liver Injury and Failure. Vet. Clin. North Am. Small Anim. Pract., 47(3): 617–630. doi: 10.1016/j.cvsm.2016.11.010.
42. Sultana H., Komai M., Shirakawa H. (2021) The Role of Vitamin K in Cholestatic Liver Disease. Nutrients, 13(8): 2515. doi: 10.3390/nu13082515.
43. Pavlidis E.T., Pavlidis T.E. (2018) Pathophysiological consequences of obstructive jaundice and perioperative management. Hepatobiliary Pancreat. Dis. Int., 17(1): 17–21.