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Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Bile reflux index after therapeutic biliary procedures.
Sedef Kuran1, Erkan Parlak, Gulden Aydog
1Gastroenterology Department, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey. sedefozdal@hotmail.com
BMC Gastroenterology
|February 13, 2008
Summary
Therapeutic biliary procedures increase bile reflux index (BRI) positivity, particularly after choledochoduodenostomy. These procedures, even without cholecystectomy, elevate BRI, indicating duodenogastric reflux (DGR).
Area of Science:
- Gastroenterology
- Biliary Medicine
- Histopathology
Background:
- Biliary procedures can impair sphincter of Oddi function, leading to potential bile reflux.
- Duodenogastric reflux (DGR) is a clinical concern following these interventions.
- The histology-based bile reflux index (BRI) is a marker for assessing DGR.
Purpose of the Study:
- To evaluate the impact of therapeutic biliary procedures on the bile reflux index (BRI).
- To determine if these procedures alter histological markers of duodenogastric reflux (DGR).
Main Methods:
- Gastric biopsies (antrum and corpus) were analyzed from 131 patients.
- Patients were categorized into groups based on biliary procedures (sphincterotomy, stenting, choledochoduodenostomy, cholecystectomy alone, Billroth II) and controls.
- Comparisons were made considering Helicobacter pylori (Hp) colonization status.
Main Results:
- Helicobacter pylori (Hp) negative patients undergoing biliary procedures showed increased BRI positivity.
- Choledochoduodenostomy resulted in the highest BRI positivity rates (85.7%) in Hp-negative patients.
- Biliary procedures without cholecystectomy also showed elevated BRI compared to controls, similar to post-cholecystectomy patients.
Conclusions:
- Therapeutic biliary procedures are associated with increased bile-related histological changes.
- Choledochoduodenostomy significantly increases the rate of positive bile reflux index (BRI).
- Biliary interventions without prior cholecystectomy also elevate BRI, suggesting DGR.
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