The American journal of gastroenterology
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Am. J. Gastroenterol. · Sep 1994
Etiology and incidence of unconjugated hyperbilirubinemia after orthotopic liver transplantation.
Gilbert's syndrome, or slow bilirubin glucuronidation phenotype, is a common cause of benign hyperbilirubinemia in the general population. There have been only two previously reported cases of Gilbert's syndrome occurring in patients after liver transplantation. This study was conducted to determine the frequency of Gilbert's syndrome in liver transplant recipients. ⋯ This study was performed to determine the incidence of unconjugated hyperbilirubinemia and particularly to determine the incidence of Gilbert's disease in liver transplant recipients. The apparently low frequency of Gilbert's after liver transplantation may reflect the masking of the diagnosis by other transplant-associated pathology or donor selection bias because of unexplained hyperbilirubinemia. Post-transplant patients who fit the Gilbert's syndrome profile of unconjugated hyperbilirubinemia should have a postprandial bilirubin drawn as a first step. The awareness of this syndrome may avoid a costly and invasive evaluation in the liver transplant recipient.
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Am. J. Gastroenterol. · Sep 1994
Comparative StudyClues to patient dissatisfaction with conscious sedation for colonoscopy.
Most colonoscopy is performed using conscious sedation to facilitate the procedure. However, little is known about which patients are dissatisfied with sedation and why. The goal of this study was to examine whether certain patient- and procedure-specific variables are associated with patient dissatisfaction. ⋯ Highly educated patients and those who underwent longer procedures were more likely to be dissatisfied with conscious sedation used for colonoscopy. A thorough discussion of expectations and/or patient-controlled sedation might improve satisfaction with colonoscopy in educated patients. Regular supplementation of sedation, termination of a lengthy procedure with the offer of a further attempt at a later date, and referral to a more experienced endoscopist when appropriate might all improve patient satisfaction with colonoscopy.
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The goal of this study was to evaluate the feasibility of endoscopic management of complications encountered in patients undergoing laparoscopic cholecystectomy. Special attention was given to establishing the optimal timing, success rate, and complications of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) after laparoscopic cholecystectomy. ⋯ Diagnostic and therapeutic ERCP can be done within 24 h of LC with safety and a high degree of success. Delay in removal of CBD stones may lead to complications. Cystic duct stump leaks are easily corrected with nasobiliary drainage, and some post-LC strictures may be amenable to therapy with biliary stents. Finally, malignancy must be excluded in patients with unexplained recurrent symptoms.