Biliary perestroika

Article Abstract:

There is a growing number of medical areas in which there is duplication of services and competing economic and professional interests. Treatment of biliary (gallbladder related) and pancreatic disease is an example. There is increased use of interventional endoscopic techniques, procedures carried out using an endoscope (an illuminated optic instrument inserted into a body cavity). Endoscopes can be fitted with various surgical tools such as snares and forceps to perform surgical procedures. It has been said that in 20 years, major abdominal surgery will rarely be performed because of the availability of these new techniques. If this is true, substantial reorganization of surgical training in biliary and pancreatic surgery is necessary. Although surgeons consider these areas to be within their sphere of influence, it is possible that as endoscopic techniques gain acceptance and improve, surgeons may become more removed from both diagnosis and treatment of these diseases. The skill required to treat biliary disease using interventional endoscopy requires that the physician's practice be focused on this area. An organized team approach including surgeons, interventional endoscopists and radiologists might be established for the treatment of biliary and pancreatic diseases. This would give the patient the benefit of multidisciplinary care, and would streamline diagnosis, foster development of newer methods, and at the same time reduce competition between specialties. A new kind of physician might evolve, such as a physician who is neither totally medical nor totally surgical in his approach to biliary disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Practice, Training, Surgeons, Endoscopic surgery, editorial, Gallbladder

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Biliary diversion for pancreatic carcinoma: matching the methods and the patient

Article Abstract:

The surgical treatment of patients with pancreatic cancer has changed with the introduction of percutaneous and endoscopic techniques. These methods are utilized for obtaining tissue for study and for decompression of the biliary system. A retrospective analysis was undertaken of 211 patients with adenocarcinoma of the pancreas. Seventy patients underwent biliary-enteric anastomosis (surgery joining the biliary system to the intestinal system), and 42 patients had percutaneous/endoscopic placement of a biliary drainage catheter. The remainder of the patients underwent other surgery or were diagnosed at autopsy. Of the patients undergoing biliary-enteric anastomosis, 39 patients had only biliary bypass performed; there were no deaths in this group. Among the remaining 31 patients who had biliary-enteric anastomosis, the mortality was 2 percent. In the group undergoing biliary catheter drainage, 61 percent developed septicemia (bacterial infection of the blood) and 27 percent of the catheters became occluded, or blocked. The average patient survival of this group was 64 days. It is recommended, in view of the morbidity and mortality, that the biliary catheter drainage procedure be used only for patients who have distant spread of their cancer. Operative biliary bypass and decompression is recommended in the early stages of pancreatic cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pancreatic cancer, Biliary tract

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