Drainage For Malignant Obstructive Jaundice Research Articles

Preliminary application of brachytherapy with double-strand 125I seeds and biliary drainage for malignant obstructive jaundice.

To evaluate the efficacy and safety of brachytherapy with double-strand 125I seeds and biliary drainage for malignant obstructive jaundice. 42 patients with obstructive jaundice because of extrahepatic cholangiocarcinoma were enrolled. 22 patients (group A) received a biliary stent with common drainage tube implantation, and 20 patients (group B) received a biliary stent with double-strand 125I seeds radiotherapy drainage tube placement. The length, location and pathological stage of biliary stricture were recorded in the two groups. Total bilirubin (TBIL), direct bilirubin (DBIL), IgA, IgG, IgM, alanine aminotransferase and white blood cell (WBC) count were measured before and after percutaneous transhepatic cholangial drainage (PTCD). Tumor diameter was measured before and three months after PTCD, and the difference were calculated. Stent patency time, survival time, and complications were recorded. There was no significant difference in the length, location and pathological stage of biliary stenosis between the two groups. There was no significant difference in TBIL, DBIL, IgA, IgG, IgM, alanine aminotransferase and WBC count between the two groups before or after PTCD (P > 0.05). Three months after PTCD, tumors growth in group A and tumors shrinkage in group B. The difference in tumor size between the two groups before and after PTCD was statistically significant (P < 0.05). The average stent patency times in groups A and B were 3.55 ± 0.76months and 8.76 ± 1.85months, respectively (P < 0.05). The average survival times in groups A and B were 133.5 ± 27.8days and 252.5 ± 114.5days, respectively (P < 0.05). There was no statistically significant difference in the incidence of complications between the two groups (P > 0.05). Double-strand 125I seeds radiotherapy biliary drainage tubes can safely and effectively control tumors, prolong the patency of biliary stents, and prolong patient survival.

Obstructive jaundice in pancreatic malignancy - primary biliary drainage with stenting or upfront surgery?

Introduction: There is currently no clear consensus whether to proceed for pre-operative biliary drainage for malignant obstructive jaundice versus upfront pancreaticoduodenectomy (PD). This study seeks to compare pre-operative biliary drainage with stenting vs upfront PD for jaundiced patients with a resectable pancreatic malignancy. The primary outcome measure was overall postoperative complications.

Differentiated approach to the minimally invasive management of malignant obstructive jaundice

Attitude towards preoperative biliary drainage for malignant obstructive jaundice have recently changed twice. This is due certain factors including complications of minimally invasive biliary drainage, level of bile duct block, cholangitis, need for neoadjuvant chemotherapy, time to scheduled surgery, severe general condition of patient, future liver remnant volume. We comprehensively searched PUBMED, MD Consult and National Library of Medicine using the following keywords: “obstructive jaundice (OJ)”, “cellular immunity”, “preoperative biliary drainage”, “selective biliary drainage”, “distal and proximal bile duct block”, “complications”. Randomized clinical trials and meta-analyzes, opinions of reputable specialists in hepatopancreatobiliary surgery and our own experimental and clinical studies were foreground. The analysis showed that preoperative biliary drainage is not a safe procedure and results an increased number of complications. Absolute indications for preoperative biliary drainage are cholangitis, need for neoadjuvant chemotherapy, increased risk of radical surgery and unresectable tumor. Future liver remnant volume should be considered in patients with portal cholangiocarcinoma followed by proximal block to determine indications for preoperative biliary drainage.

Value of endoscopic ultrasonography-guided biliary drainage for malignant obstructive jaundice(with video)

Objective To analyze the efficacy of endoscopic ultrasonography-guided biliary drainage (EUS-BD) for malignant obstructive jaundice and the management of adverse events. Methods Clinical data of 12 patients with malignant obstructive jaundice, who underwent EUS-BD between April 2016 and January 2017, were retrospectively analyzed. All patients received EUS-BD after unsuccessful ERCP, including EUS-guided hepaticogastrostomy (EUS-HGS), EUS-guided antegrade stenting (EUS-AS), and EUS-guided choledochoduodenostomy(EUS-CDS). Procedure outcomes, serum bilirubin and liver enzyme levels before the procedure and 1 week after, complications, treatment results, hospitalization time and follow-up were recorded. Results Two patients underwent EUS-HGS, 3 underwent EUS-AS, and 7 underwent EUS-CDS. Total bilirubin (t=3.462, P=0.005), direct bilirubin (t=3.351, P=0.006), alanine transaminase (t=2.399, P=0.037), γ-glutamate transpeptidase (t=3.256, P=0.031) reduced significantly after the procedure. Two patients (16.67%) developed complications. A patient undergoing EUS-HGS developed bile leakage, biliary peritonitis, and pneumoperitoneum. A patient undergoing EUS-CDS developed upper gastrointestinal bleeding. Both patients were successfully treated. There were no other adverse events, such as acute pancreatitis, subcutaneous emphysema, pneumothorax and emphysema. No procedure-related death occurred. The mean hospital stay was 13.75 ±6.92 days (range 5-26 days). Conclusion EUS-BD is a safe substitute after unsuccessful ERCP when performed by experienced biliary endoscopists. However, intensive care is necessary after the procedure for early detection and management of complications. Key words: Endosonography; Biliary drainage; Hepaticogastrostomy; Choledochoduodenostomy; Complication

Clinical outcomes and prediction of survival following percutaneous biliary drainage for malignant obstructive jaundice.

The present study aimed to investigate the clinical outcomes of percutaneous transhepatic biliary drainage in patients with obstructive jaundice and identify potential predictors of patient survival. Clinical data from 102 patients (66 males and 36 females; median age, 63.50 years; range, 29–84 years) with a mean (± standard deviation) pre-drainage serum bilirubin level of 285.4 (±136.7 μmol/l), were retrospectively studied. Technical and clinical success, complications and survival time were recorded and their relationship with clinical factors, including age, obstruction level, liver metastases, serum bilirubin level and subsequent treatments following drainage, were analyzed by Fisher’s exact test. Patient survival rate and other predictors were analyzed by Kaplan-Meier survival curves and Cox’s proportional hazard model. The technical and clinical success rates were 100 and 76.5%, respectively. The presence of liver metastases was associated with reduced successful drainage. The overall complication rate was 7.8% and the overall median survival time was 185 days [95% confidence interval (CI), 159–211 days]. A log-rank test showed that age (χ2, 4.003; P=0.04), bilirubin levels following procedure (χ2, 5.139; P=0.02) and subsequent therapy (χ2, 15.459; P=0.00) affected survival time. However, Cox’s regression analysis revealed no administration of additional treatments to be a risk factor of survival (odds ratio, 2.323; 95% CI, 1.465–3.685; P=0.000). Percutaneous transhepatic biliary drainage for malignant biliary obstruction was found to be a safe and effective method to relieve jaundice caused by progressive neoplasms. Subsequent radical therapy following drainage, including surgery, chemotherapy and other local treatment types, are likely to increase patient survival.

Risk factors for in-hospital mortality in patients underwent pertaneous transhepatic biliary drainage with malignant obstructive jaundice: a prospective study

Objective In-hospital mortality rate in patients undergoing percutanous transhepatic biliary drainage for malignant obstructive jaundice remained high.This study aimed to assess pre-,intra-and post-procedure risk factors which were independently associated with increased in-hospital mortality.Methods One hundred and fifty-five consecutive patients with malignant obstructive jaundice received initial PTBD drainage.Twenty-five pre-procedure,4 intra-procedure and 6 post-procedure factors potentially related with in-hospital mortality were assessed by univariate and multivariate analysis.Results In-hospital mortality rate was 16.8％ (26/155).Of 25 pre-procedure variables analysed,Child-Pugh classification C,creatinine (≥ 6.93 μmol/L) and quality of life (≤ 30) were found to be significant in univariate and multivariate analysis.Increased mortality was seen in this study with two or more risk factors,significantly different from patients who had none or one risk factor(P ＜0.01).None of the intra-procedure factors were important in identifying patients at risk of death.Multivariate analysis indicated post-PTBD cholangitis and unsuccessful drainage as post-procedure risk factors that correlated with in-hospital death.Conclusions Three pre-procedure and two post-procedure risk factors were identified associated with in-hospital mortality. Key words: Jaundice, obstructive; Drainage ; Hospital mortality ; Risk factors

Clinical Outcomes, and Long-Term Stent Patency in Patients with Malignant Biliary Obstruction: A Systematic Review and Meta-Analysis

Purpose: Endoscopic biliary drainage for malignant obstructive jaundice is a viable alternative, but its exact role and the clinical outcomes of the various available stents are subject to debate. The objective of this study was to review the literature with regard to the clinical outcomes, patency rates, and quality of life in patients requiring endoscopic palliation for malignant obstructive jaundice. Methods: Using PubMed, Medline, Embase, Current Contents, and the Cochrane Database of Systematic Reviews databases, a literature search was performed for papers published from January 1990 to December 2006. All retrieved papers comparing plastic with metallic stents for palliative biliary decompression, were rated according to the strength of evidence and analyzed. Results: A total of 566 patients were included in our analysis. 273 (48%) patients had plastic stents, and 293 (52%) had metallic stents. The age of the patients was 21–96 years, with a median age of 72.50 years. The median age for the plastic stent group was 73.01 years (36–96), and that of the metallic stent group was 72.09 years (21–94), which was not statistically significant (P= 0.84). The median time of stent patency was 187.7 days for the metal stents, and 95.1 days for the plastic stents, (P < 0.002). While the quality of life was better for all of the patients undergoing palliative endoscopic drainage, there was no evidence of a difference in the technical success, or complication rates between the two groups. However, the median patient survival was statically higher (P < 0.001) in the metal stents group than the plastic stents group (243 vs. 190 days). Conclusion: Palliative endoscopic drainage affords improved quality of life. With better patency rate and improved survival, clinicians should consider using a metal stent as the prefered option in the management of malignant biliary strictures.[figure1][figure2]FigureFigure

Clinical Outcomes, Survival Benefits, and Long-Term Stent Patency in Patients with Malignant Biliary Obstruction: A Systematic Review and Meta-Analysis

Purpose: Endoscopic biliary drainage for malignant obstructive jaundice is a viable and popular alternative, but its exact role and the clinical outcomes of the various available stents are subject to debate. The objective of this study was to review the literature with regard to the clinical outcomes, patency rates, and quality of life in patients requiring endoscopic palliation for malignant obstructive jaundice. Methods: Using PubMed, Medline, Embase, Current Contents, and the Cochrane Database of Systematic Reviews databases (OVID), a literature search was performed for papers published from January 1990 to December 2006. All retrieved papers comparing plastic with metallic stents for palliative biliary decompression, were rated according to the strength of evidence and carefully analyzed. Results: A total of 566 patients were included in our analysis. 273 (48%) patients had plastic stents, and 293 (52%) had metallic stents. In the plastic stent group 144 patients (53%) were males, and 129 (47%) were females. In the metallic stent group 155 patients (53%) were males and 138 (47%) were females. The age of the patients was 21–96 years, with a median age of 72.50 years. The median age for the plastic stent group was 73.01 years (36–96), and that of the metallic stent group was 72.09 years (21–94), which was not statistically significant (P= 0.84). Based on our meta-analysis, the median time of stent patency was 187.7 days for the metal stents, and 95.1 days for the plastic stents, which is statistically significant (P < 0.002). While the quality of life was better for all of the patients undergoing palliative endoscopic drainage, there was no evidence of a difference in the technical or therapeutic success, or complication rates between the two groups. However, the median patient survival was also statically higher (P < 0.001) in the metal stents group than the plastic stents group (243 days vs. 190 days). Conclusion: Palliative endoscopic drainage affords improved quality of life. With better patency rate and improved patient survival, clinicians should consider using a metal stent as first preference, when there is no other contraindication, in the management of malignant biliary strictures.

Endobiliary Stents for Palliation in Patients With Malignant Obstructive Jaundice

Endobiliary drainage for malignant obstructive jaundice presents a viable palliative alternative. Its role and efficacy depend on factors related to the stent, procedure, and patient. To review the evidence in the literature in which settings plastic or metal stents are cost-effective, and whether adjuvant measures or patient-related factors affect duration of stent patency. Using databases a literature search was performed for papers published from 1979 to April 2004. All retrieved papers reporting experimental or clinical observations were rated according to strength of evidence, and carefully analyzed. Metal stents (Wallstent) stay patent longer than plastic stents (large-bore polyethylene with side-holes), overall median 250 and 110 days, respectively, and seem cost-effective in patients with longer than about 6 months survival, which cannot be accurately predicted. Antibiotics or choleretic agents do not prolong stent patency in clinical settings. In case of stent occlusion, indicated stent exchanges and insertion of a plastic stent, respectively, seem cost-effective in patients initially treated with plastic and metal stents.

Usefulness of Preoperative Biliary Drainage for Malignant Obstructive Jaundice

Usefulness of Preoperative Biliary Drainage for Malignant Obstructive Jaundice

Endoscopic Biliary Drainage for Malignant Obstructive Jaundice: Clinical Analysis and Assessment of Biliary Decompression

Abstract: The efficiency of non‐operative methods of biliary decompression was evaluated in 74 patients with malignant obstructive jaundice.Endoscopic biliary drainage (EBD) was performed in 54 patients and included nasobiliary drainage (NBD) in 18 patients, duodenobiliary drainage with a endoprosthetic tube measuring 7. 2 Fr in diameter (7.2DB) in 22 patients and duodenobiliary drainage with a endoprosthetic tube measuring 10 Fr in diameter (10DB) in 14 patients. 20 patients had percutaneous transhepatic biliary drainage (PTBD).A “Jaundice Reduction Index” was calculated for each group using the regression coefficient analysis of the fall in serum bilirubin levels measured at 1 week intervals. Values of 0.23, 0.30, 0.62 and 0.65 were obtained for the 10DB, 7.2DB, NBD and PTBD groups respectively.Our results indicate a statistically significant superiority in the efficiency of biliary decompression in the 10DB and 7.2DB patients when compared with the NBD and PTBD patients. The difference between the 10DB and the 7.2DB groups was not statistically significant. Moreover, endoprosthesis using a stent tube, measuring 7.2 Fr in diameter, provided sufficient biliary decompression on initial drainage. A stent tube with a larger diameter is preferable for endoprosthesis, but our results suggest that the use of stent tube with a bigger internal diameter is not necessary for the increased efficiency of biliary decompression.