Israel Medical Association Journal

In this study, we assessed the efficacy and outcomes of percutaneous cholecystostomy with cystic duct cannulation for biliary drainage in patients in whom conventional endoscopic retrograde cholangiopancreatography (ERCP) was either unsuccessful or contraindicated. In addition, we provide a contemporary review of this technique. We retrospectively reviewed data of 323 consecutive patients who underwent percutaneous gallbladder drainage at our institution between 2017 and 2022. Transcholecystic common bile duct (CBD) cannulation via the cystic duct was attempted in six carefully selected patients in whom ERCP was not feasible or had failed, or who were unfit for endoscopy. Four technically successful cases are described in detail. Two additional attempts were unsuccessful due to inability to traverse the cystic duct. A focused literature review examined the historical development and contemporary applications of transcholecystic biliary intervention. Transcholecystic cannulation of the common bile duct is not routinely performed at our institution. Percutaneous cholecystostomy with cystic duct cannulation is a well-established technique with over five decades of documented use. This approach provides a viable and safe alternative to biliary drainage in complex cases in which traditional methods are not feasible, particularly in high-risk patients with anatomical challenges.

Background: The presence of stones in the common bile duct (CBD) may cause complications such as obstructing jaundice or ascending cholangitis, and the stones should be removed.

0bjectives: To report our results with percutaneous elimination of CBD stones from the gallbladder through the papilla.

Methods: During a 4 year period, six patients (five men and one woman, mean age 71.5 years) who had CBD stones and an existing gallbladder drain underwent percutaneous stone push into the duodenum after balloon dilatation of the papilla, with a diameter equal to that of the largest stone. Access into the CBD was from the gallbladder, using an already existing percutaneous gallbladder drain (cholecystostomy tube).

Results: Each patient had one to three CBD stones measuring 7–14 mm. Successful CBD stone elimination into the duodenum was achieved in five of the six patients. The single failure occurred in a patient with choledochal diverticulum, who was operated successfully. There were no major or minor complications during or after the procedures.

Conclusions: Trans-cholecystic CBD stone elimination is a safe and feasible percutaneous technique that utilizes existing tracts, thus obviating the need to create new percutaneous access. This procedure can replace endoscopic or surgical CBD exploration.
 

Background: Vitamin A and its derivative retinoic acid regulate various aspects of cell behavior as growth, differentiation, and proliferation. Retinoic acid derivatives have been suggested to play a role in processes such as hepatic regeneration and fibrosis.

Objectives: To evaluate the influence of vitamin A on rat liver epithelial cell proliferation.

Methods: We performed common bile duct ligation in rats that had been subjected to differing vitamin A diets and compared their livers to control rats. Proliferation, apoptosis, and retinoic acid receptors were evaluated by histology and immunohistochemistry in bile duct cells and hepatocytes.

Results: Vitamin A deficiency was found to be associated with enhanced proliferation of bile duct epithelial cells following CBD[1] ligation. The proliferation was manifested by increased numbers of ducts, by aberrant extended ductal morphology, and by elevated numbers of nuclei expressing the proliferation marker Ki67. The amount of vitamin A in the rat diet did not affect detectably ductal cell apoptosis. We observed up-regulated expression of the retinoid X receptor-alpha in the biliary epithelium of vitamin A-deficient rats that had undergone CBD ligation, but not in vitamin A-sufficient rats.

Conclusions: We speculate that the mechanism underlying the ductal proliferation response involves differential expression of RXR[2]-alpha. Our observations suggest that deficiency of vitamin A may exacerbate cholestasis, due to excessive intrahepatic bile duct proliferation.