Decompression Of Biliary Obstruction Research Articles

Management of extra hepatic biliary obstruction, in a rural tertiary care hospital India

Background: Extra hepatic biliary obstruction (EHBO) is not a rare surgical problem; our experience in managing 36 patients over a period of two years at a tertiary care hospital in a rural setting in India. The objective was to study the etiology and clinical presentation of patients with EHBO, role of various investigative modalities and management strategies in these patients and their outcome.Methods: This was a prospective study conducted between September 2018 to August 2020 in the department of surgery in tertiary care center Subharti medical college (SMC) Meerut. Data was taken in a pre-formed performa and the results were tabulated and analyzed (descriptive analysis).Results: Out of 36 patients, 2 (5.5%) patients underwent choledochoduodenostomy, 1 (2.7%) exploratory laparotomy with CBD exploration with t tube drainage, 1 (2.7%) ERCP with pigtail drainage; 17(47.2%) ERCP (endoscopic retrograde cholangiopancreatography) followed by cholecystectomy, 1 (2.7%) open cholecystectomy with t tube drainage, 4 (11.1%) ERCP alone, 2 (5.5%) hepaticojejunostomy, 1 (2.7%) ERCP followed by diverticulectomy, 2 (5.5%) PTBD (percutaneous transhepatic biliary drainage) followed by a triple bypass surgery, 2 (5.5%) PTBD, 1 (2.7%) pylorus preserving pancreaticoduodenectomy, 1 (2.7%) ERCP with sphincterotomy, 1 (2.7%) PTBD followed by whipples procedure. Patients were followed up and 5 (13.8%) patients had recurrence of the disease.Conclusions: EHBO is a hepatobiliary surgical condition caused by both neoplastic and non-neoplastic etiology. Benign pathologies common in younger patients whereas neoplastic conditions in older age. Ultrasonography is the most common investigative modality followed by ERCP with PTBD/ENBD playing an important role in decompression of biliary obstruction as a palliative measure in advanced malignancies.

Irreversible Electroporation Treatment With Intraoperative Biliary Stenting for Unresectable Perihilar Cholangiocarcinoma: A Pilot Study.

BackgroundTreating perihilar cholangiocarcinoma (PHCC) is particularly difficult due to the fact that it is usually in an advanced stage at the time of diagnosis. Irreversible electroporation treatment (IRE) involves the local administration of a high-voltage electric current to target lesions without causing damage to surrounding structures. This study investigated the safety and efficacy of using IRE in conjunction with intraoperative biliary stent placement in cases of unresectable PHCC.MethodsThis study enrolled 17 patients with unresectable Bismuth type III/IV PHCC who underwent IRE in conjunction with intraoperative biliary stent placement (laparotomic) in two medical centers in Asia between June 2015 and July 2018. Analysis focused on the perioperative clinical course, the efficacy of biliary decompression, and outcomes (survival).ResultsMean total serum bilirubin levels (mg/dL) on postoperative day (POD) 7, POD30, and POD90 were significantly lower than before IRE (respectively 3.46 vs 4.54, p=0.007; 1.21 vs 4.54, p<0.001; 1.99 vs 4.54, p<0.001). Mean serum carbohydrate antigen 19-9 (CA19-9, U/ml) levels were significantly higher on POD3 than before the operation (518.8 vs 372.4, p=0.001) and significantly lower on POD30 and POD90 (respectively 113.7 vs 372.4, p<0.001; 63.9 vs 372.4, p<0.001). No cases of Clavien-Dindo grade III/IV adverse events or mortality occurred within 90 days post-op. The median progression-free survival was 21.5 months, and the median overall survival was 27.9 months. All individuals who survived for at least one year did so without the need to carry percutaneous biliary drainage (PTBD) tubes.ConclusionsIt appears that IRE treatment in conjunction with intraoperative biliary stent placement is a safe and effective approach to treating unresectable PHCC. The decompression of biliary obstruction without the need for PTBD tubes is also expected to improve the quality of life of patients.

Evaluation of liver function by means of serum cytokeratin 18 and hepatocyte growth factor levels in patients with obstructive jaundice

Objective: To evaluate the serum levels of cytokeratin 18 (CK18) and hepatocyte growth factor (HGF) in obstructive jaundice patients before and after treatment and thereby to detect the possible role of CK18 and HGF in patients with obstructive jaundice.Patients and methods: Forty patients who had obstructive jaundice and 40 healthy control subjects were included in the study. Patients were treated using percutaneous, endoscopic or surgical approaches. Blood samples were obtained at the day before and 7 days after the intervention for obstructive jaundice. Serum HGF and CK18 concentrations were determined by ELISA method.Results: There were statistically significant decreases in HGF, CK18, total bilirubin and direct bilirubin serum levels, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase, and alkaline phosphatase activities and white blood cell count when compared with pre-treatment levels.Conclusion: Evaluating pre- and post-treatment serum HGF and CK18 levels suggested that there was an apoptosis in obstructive jaundice patients and this apoptosis decreased after the decompression of the biliary tract. We also demonstrated that HGF levels were altered at biliary obstruction compared to healthy controls and the levels of this biomarker also decreased after decompression of biliary obstruction. We concluded that these biomarkers can be used as predictors of liver injury in biliary obstruction.

S1939 Prospective Analysis of the Role of CA 19-9 Levels Before and After Endoscopic Decompression of Biliary Obstruction in Differentiating Benign From Malignant Etiologies of Biliary Obstruction

Introduction: The whole genomic microarrays can contribute to high-throughput biomarker screening in colorectal diseases, but the further possible diagnostic utilization of the markers requires testing their classificatory efficacy on an independent sample set. Aims: Our aims were to identify characteristic transcript sets in order to develop diagnostic mRNA expression patterns for objective classification of benign and malignant colorectal diseases and to test their classificatory power on an independent biopsy set. Material and methods: Gene expression profiles were evaluated on HGU133plus2 microarrays from colonic biopsies of 22 patients with colorectal cancer (CRC), 20 with adenoma, 21 with IBD and 11 healthy controls. For classification Prediction Analysis of Microarrays were used. The previously determined classificatory transcript sets were tested on independent samples (27 CRC, 29 adenoma, 28 IBD and 38 normal controls). Array real-time PCR validation was done on 68 independent biopsy specimen (24 CRC, 24 adenoma, 20 normal controls). Receiving operating characteristic (ROC) curve analysis was used to evaluate the discriminatory power of the gene panels. Results: Between normal and CRC samples 38 classifiers were identified by microarray analysis including upregulated CXCL1 and CXCL2 oncogenes, osteopontin and downregulated carbonic anhydrase 7. According to these classifiers, the independent CRC and normal biopsies could be clearly separated by 97.4% specificity and 96.3% sensitivity. Adenoma and normal samples could be classified using 20 discriminatory transcripts such as overexpressed cadherin 3, KIAA1199, forkhead box Q1 and downregulated claudin 8, peptide YY. Using these classifiers, independent adenoma and healthy samples could be distinguished with 94.7% specificity and 100% sensitivity. The microarray results were confirmed on independent biopsies using real-time PCR cards. Discriminatory power of the CRC vs. normal gene panel is proved to be considerably high in array real-time PCR (sensitivity: 91.7 %, specificity: 95.0 %). According to the real-time PCR results, adenoma and healthy samples could be clearly separated, only 2 of the 24 adenoma samples were grouped into the normal cluster. The ROC curve analysis showed 95.8% sensitivity and 100% specificity values. Conclusion: Discriminatory transcripts were identified which could correctly classify CRC and adenoma biopsies also on a large independent sample set. These markers can establish the basis of gene expression based diagnostic classification of benign and malignant colorectal diseases. Diagnostic real-time PCR cards can become part of the automated routine procedure.

W1886 Change in CA 19-9 Levels Post-ERCP Decompression of Biliary Obstruction: A Potential Method to Differentiate Benign from Malignant Etiologies of Biliary Obstruction

W1886 Change in CA 19-9 Levels Post-ERCP Decompression of Biliary Obstruction: A Potential Method to Differentiate Benign from Malignant Etiologies of Biliary Obstruction

Case report: Broken intracholedochal stent

Decompression of biliary obstruction by an internal stent is well accepted in patients with malignant strictures. Less frequent is the use of this technique for the management of benign disorders. In the latter situation the biliary stent may be left in place for a very long period. We report a rare complication of a broken intracholedochal stent which had been inserted for a benign post-operative stricture.

Percutaneous cholecystostomy: diagnostic and therapeutic efficacy.

Percutaneous cholecystostomy was performed in 32 patients for treatment of suspected cholecystitis (16 patients), decompression of biliary obstruction (six patients), or performance of diagnostic cholangiography (ten patients). The gallbladder was successfully catheterized in 32 of 32 patients (100%), and therapeutic or diagnostic benefit was achieved in 29 of 32 patients (91%). There were no major complications and no procedure-related deaths. There were four minor complications. In the 14 patients with severe cholecystitis there was substantial clinical improvement in 13. Five patients underwent catheter withdrawal after stabilization or long-term drainage. In biliary obstruction, hyperbilirubinemia was successfully treated with percutaneous cholecystostomy in five of six patients, and associated cholangitis was successfully treated in four of four. Ten patients underwent transcholecystic cholangiography; diagnostic visualization was achieved in all, including seven who underwent percutaneous cholecystostomy-assisted transhepatic biliary drainage. Percutaneous cholecystostomy is a safe and effective procedure in diagnosis and treatment of biliary tract problems.

Successful long-term percutaneous decompression of the biliary tract

The efficacy of percutaneous transhepatic biliary drainage for long-term (greater than 3 months) decompression of biliary obstruction was evaluated in 35 patients with benign (10) and malignant (25) obstructing lesions. The results indicate that such drainage is a safe and effective means for long-term decompression of the biliary tract in selected patients, especially patients who are poor operative risks and those with metastatic or nonresectable malignancy. In addition, the procedure provides access to the biliary tract for percutaneous dilatation of selected common duct or anastomotic strictures.