Palliation of proximal malignant biliary obstruction by endoscopic endoprosthesis insertion

Article Abstract:

Bile, a fluid produced in the liver, flows by way of the hepatic bile duct and common bile duct into the small intestine, where it aids in the digestion of fats and oils. In some conditions, such as cancer of the gall bladder, pancreas, liver, and other types of malignant disease, the biliary system can become obstructed, resulting in pain, nausea, and digestive difficulties. When the blockage occurs near the inlet to the intestine, treatment by endoprosthesis insertion (placement of a tube, called a stent, that forces the duct to remain open) is a common procedure. In cases where the blockage occurs close to the liver (proximal malignant biliary obstruction), however, stent placement is controversial. To evaluate the success of endoscopic stent insertion (placement of the device using a flexible fiberoptic viewing tube introduced into the biliary system), the results of 190 patients who underwent this procedure were reviewed. The patients suffered from bile duct cancer (101 patients), gall bladder cancer (21 patients), spread of pancreatic cancer (20 patients), and cancer that had spread from other sites (48 patients). Insertion of the stent was successful on the first attempt in 127 cases and on the second attempt in 30 cases. A combined procedure using endoscopy and another approach was necessary for 13 patients. Adequate biliary drainage was achieved in 152 of these 170 cases; after 3 more patients underwent a second successful stent placement, the overall success rate of the procedure was 82 percent. Early complications (inflammation of the bile duct or pancreas, gastrointestinal bleeding, bile leakage, movement of the stent) occurred in approximately 25 percent of the cases. Eighty patients underwent between one and six subsequent stent changes. The procedure can be recommended as palliation for patients with malignancies obstructing the proximal bile duct that cannot be treated surgically. (Consumer Summary produced by Reliance Medical Information, Inc.)

Palliative care, Cancer, Cancer treatment, Bile ducts, Endoscopic surgery, Digestive system diseases

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A 10 year single centre experience of percutaneous and endoscopic extraction of bile stones with T tube in situ

Article Abstract:

The bile duct carries bile from the liver (where it is produced) to the intestine (where it is involved in the digestion of fats) by way of the gall bladder. Frequently, precipitated solids can crystallize out of the bile, resulting in the painful and potentially dangerous condition known as gall stones or bile stones (depending upon their location). The removal of gall stones is relatively straightforward, and is accomplished either by removing the gall bladder, or by chemical or mechanical destruction of the gall stones. Bile stones, which may either be primary or left over from prior treatment of gall stones, are less easily treated. Several of the potential treatments for bile stones are associated with significant postoperative sickness and death, and do not have acceptably high success rates. Direct comparisons between the most promising of the treatment strategies have not been carried out. A study was undertaken to evaluate and compare two of these methods: percutaneous (accessing the bile ducts via tubes inserted through the skin and abdominal musculature) and endoscopic (passing a flexible fiber-optic viewing device into the intestines and extracting the stone with a special steerable catheter and basket device). Percutaneous extraction was attempted in 204 patients following insertion of a bile duct catheter; success was achieved in 158 (77.7 percent). Endoscopic extraction was attempted in 68 patients; success was achieved in 52 (76.5 percent). The incidence of major complications, such as perforation of the bile duct and major bleeding, was the same for both procedures (3.9 and 4.4 percent for percutaneous and endoscopic extraction, respectively). In cases where the initial procedure was not successful, the alternate method was attempted, resulting in an overall success rate of 94.3 percent. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Biliary tract diseases

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Additional endoscopic procedures instead of urgent surgery for retained common bile duct stones

Article Abstract:

After a non-surgical procedure (endoscopy) on 127 patients failed to remove a stone from the common bile duct, fluid was drained to prevent obstruction in the bile duct. Jaundice, a syndrome caused by bile pigments being deposited in the skin, had been diagnosed in 72 percent of the patients. Thirty-one percent had cholangitis, an inflammation of the bile duct. In almost all the cases (98 percent), the draining procedure, or stent, was successful. Longterm drainage or stenting can be useful for patients at poor risk for surgery. In addition, it gives patients the option of elective surgery, rather than endoscopy or required surgery.

Drainage, Surgical, Drainage (Surgical)

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