Obstructive Jaundice Patients Research Articles

Comparison of the Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography (MRCP) with Ultrasound and Computed Tomography (CT) in Evaluation of Patients with Obstructive Jaundice

Background: Obstructive jaundice patients need surgical intervention to overcome the biliary obstruction. For planning these complex interventions, the radiologist has to precisely assess the etiology, location, level, and extent of the disease.
 Aim: To compare the diagnostic benefit of Magnetic Resonance Cholangiopancreatography (MRCP) with Ultrasound and Computed Tomography (CT) in the evaluation of patients with obstructive jaundice taking histologic tests and anatomical findings after surgical intervention as gold standard.
 Study Design: This prospective study included 72 patients who were referred to DCIMCH radiology department with clinical features of biliary obstructive disease.
 Materials and Methods: All patients were evaluated by Ultrasonography followed by Computed tomography (CT) and Magnetic Resonance Cholangiopancreatography (MRCP). The results were read by radiologists blinded to other imaging findings. The characteristic histopathological diagnosis / surgical findings (as applicable) were considered as gold standard.
 Results: Diagnostic accuracy of MRCP (98%) in the diagnosis of benign and malignant diseases was relatively high (98% and 98%) as compared to CT (82.86% and 91.43% in benign and malignant respectively) and USG (88% and 88%). In the diagnosis of benign diseases, MRCP was 100% sensitive compared to ultrasound (80.77%), which was more sensitive than CT scan (54.55%).In the diagnosis of malignant diseases, MRCP was more sensitive (95.83%) as compared to CT scan (91.67%), which was more sensitive than ultrasonography (79.17%).
 Conclusion: MRCP is the best imaging investigation in the pre-operative evaluation for obstructive jaundice patients.
 J Shaheed Suhrawardy Med Coll 2022; 14(1): 32-36

Audit of adequacy of the ultrasound reports in the patients of obstructive jaundice presented to tertiary care hospital radiology department

Audit of adequacy of the ultrasound reports in the patients of obstructive jaundice presented to tertiary care hospital radiology department

Minimally invasive and open methods of bile ducts decompression for the treatment of obstructive jaundice

Annotation. Obstructive jaundice (OJ) patients account for one of the most challenging categories of patients with abdominal pathologies. Today, both open and minimally invasive bile duct decompression techniques are used in biliary surgery. However, the criteria for the selection of minimally invasive and open surgeries in patients with OJ remain undefined. The aim – assessment of the effectiveness of using minimally invasive and open methods of bile duct decompression for the treatment of OJ with due account to OJ duration, bilirubin count, the age of patients, associated complications and comorbidities. We analyzed the results of the surgical treatment of 250 patients with OJ. Statistical processing of the obtained data was carried out using the Student’s t-test. The average age was 52±6.0 years. The average duration of OJ was 19±3.5 days. Benign OJ was observed in 210 (84.0%) patients, and malignant OJ in 40 (16.0%) patients. 136 (54.4%) patients were submitted to minimally invasive surgical interventions. One-stage minimally invasive interventions were used in 38 (15.2%) cases and two-stage minimally invasive interventions in 98 (39.2%) cases. 114 (45.6%) patients underwent open surgeries. Post-operative сomplications after minimally invasive interventions were observed in 7 (5.2%) cases and 13 (11.4%) cases after open surgeries. 2 (1.7%) patients died. So, the use of minimally invasive surgical interventions for the treatment of OJ patients makes it possible to reduce the frequency of complications by 2.2 times, which is statistically significant (p<0.05). Two-stage surgical approach to the treatment of OJ patients of senior age groups is a priority. Single-stage correction is reasonable to use for young and middle-aged patients with bilirubin count under 200 μmol/l, OJ duration less than 14 days, compensated (sub-compensated) comorbidities, and not burdened by complications.

“A CLINICO-RADIOLOGICAL PRESENTATION IN PATIENTS WITH OBSTRUCTIVE JAUNDICE: A PROSPECTIVE OBSERVATIONAL STUDY”

Introduction: Obstructive jaundice is a common surgical problem. Occurs due to both benign and malignant conditions. Evaluation in patients with obstructive jaundice was a challenging problem. Presentation of obstructive jaundice patients is late and mostly present after the disease becomes advanced or uncurable. Aims And Objectives: To assess age and sex pattern, clinical presentation and radiological and biochemical pattern in obstructive jaundice patients. Material And Methods: 100 patients with obstructive jaundice were studied. Proformas form waslled and assessment of demographic and clinical patterns in benign and malignant obstructive were observed and radiological ndings in benign and malignant obstructive were carried out to assess the operability. Result: we enrolled 100 patients, 18 were male and 82 female having mean age was 52.58 yr. All patients have icterus, 60% having a lump in abdomen, 31% have pruritus. Gallbladder was palpable in 40% patients at which most were due to pancreatic and Periampullary malignancy. Our study reveals the most common overall and benign cause of biliary tract obstruction was CBD stone(33%) and most common in malignant is gall bladder carcinoma(31%) followed by Periampullary carcinoma(17%). CBD stone treated by CBD exploration(85%) and palliative treatment by ERCP(15%) and rest of benign conditions are completely treatable. Among malignant causes gallbladder carcinoma treated by radical cholecystectomy (16%), cholangiocarcinoma were mostly inoperable, Periampullary carcinoma by Whipple's procedure(25%). Conclusion: Malignant causes of obstructive jaundice outnumbered the benign causes. Most common overall and benign cause was Choleldocholithiasis and malignant was gallbladder carcinoma followed by Periampullary carcinoma. Benign causes were prevalent in younger age groups (31-40 yr) and malignant in older age groups(61-70 yr).Common presentation of obstructive jaundice was icterus and palpable gallbladder was indicative of malignant etiology. Ultrasound followed by MRCP/ERCP and CT scan was the investigation of choice. Benign conditions have better outcome and cure rate while malignant conditions were inoperable (83%).

Safety and efficacy of self-expandable metallic stent combined with 125I brachytherapy for the treatment of malignant obstructive jaundice

BackgroundSeveral previous studies demonstrated that the combination of self-expandable metallic stents (SEMS) and 125I seed implantation might prolong stent patency and obtain survival benefits for malignant obstructive jaundice (MOJ) patients. However, these studies rarely mentioned a comparison between CT-guided intratumoral 125I seed implantation and intraluminal 125I seed strand insertion combined with stenting for the management of MOJ. This study aimed to further evaluate the safety and efficacy of SEMS combined with 125I brachytherapy in the management of unresectable MOJ.MethodsFifty-nine patients with unresectable MOJ were retrospectively included from March 2018 to June 2021. The main therapeutic outcomes were evaluated in terms of stent patency, and overall survival. Cumulative stent patency and overall survival rates were calculated by Kaplan–Meier survival analysis. Both clinical and treatment factors associated with survival were analyzed.ResultsTechnical success was achieved in all patients. The clinical success rate was 94% (32/34) in the seeds group and 92% (23/25) in the control group, no significant difference was found (p =1.000). The median duration of stent patency was significantly longer in the 125I brachytherapy group compared with the control group (289 days vs. 88 days, respectively, p =0.001). The 125I brachytherapy group demonstrated a significantly better median overall survival rate than the control group (221 days vs. 78 days, respectively, p =0.001). In multivariate analysis, stents with 125I brachytherapy (p =0.004) was a significant favorable prognostic factor that affected patient survival. No significant difference was observed between CT-guided 125I seed implantation and 125I seed strand insertion in stent patency (p =0.268), and overall survival (p =0.483).ConclusionSEMS combined with 125I brachytherapy is safe and effective for treating MOJ. 125I brachytherapy may help to maintain stent patency and prolong overall survival. There was no significant difference between CT-guided 125I seed implantation with SEMS and 125I seed strand insertion with SEMS in stent patency and overall survival.

Endoscopic treatment of obstructive jaundice in patients with Klatskin tumor

To improve treatment outcomes in patients with Klatskin tumor and obstructive jaundice by using of endoscopic bilioduodenal stenting. There were 1904 transpapillary interventions between August 2017 and February 2022. Endoscopic bilioduodenal stenting was performed in 250 patients including 25 (10%) ones with Klatskin tumor. Bilioduodenal plastic and self-expanding stents were installed in 19 (76%) and 6 (24%) patients, respectively. In Klatskin tumor type I, 11 patients (44%) underwent bilioduodenal stenting of common hepatic duct with plastic stent; 5 (20%) patients with Klatskin tumor type II received self-expanding stents. In case of tumor type IIIA, 3 (12%) patients underwent stenting of the right lobar duct with plastic stent. Four (16%) patients with Klatskin tumor type III B underwent stenting of the left lobar duct. Two 2 (8%) patients with Klatskin tumor type IV underwent bilateral bilioduodenal stenting with plastic and bifurcation self-expanding stents. Peroral cholangioscopy using the SpyGlass DS system was performed in 4 (16%) patients. No intraoperative complications were identified. One (4%) patient developed gastrointestinal bleeding in 2 postoperative days after retrograde intervention that did not require surgery. Moreover, 1 (4%) patient with distal dislocation of plastic bilioduodenal stent required redo bilioduodenal stenting. Three (12%) patients died from multiple organ failure despite adequate biliary decompression, and 22 (88%) patients were discharged in 8±5 days after retrograde intervention. Bilioduodenal stenting as minimally invasive and physiological method was highly effective for obstructive jaundice in patients with Klatskin tumor. Peroral cholangioscopy using the SpyGlass system provides effective and safe direct visualization of the biliary tract, as well as biopsy for morphological verification and prescription of chemotherapy in patients with intraductal growth of tumor.

CHARACTERIZATION OF STRUCTURAL DISORDERS OF THE LIVER DEPENDING ON THE DURATION OF SUBHEPATIC CHOLESTASIS IN PATIENTS OF DIFFERENT AGE GROUPS.

The aim: To study structural disorders of the liver depending on the duration of subhepatic cholestasis in patients of different age groups. Materials and methods: 50 obstructive jaundice patients were subdivided into two groups. Group I (n = 25) consisted of young (18-44-year-old) and middle-aged patients (45-59-year-old), while the Group II (n = 25) included elderly (60-74-year-old) and senile patients (75-90-year-old). Results: We performed morphological and morphometric studies of 50 liver biopsy specimens taken from patients of different age groups with different duration of obstructive jaundice: less than 7 days, 7-14 days, 14-21 days, 21-28 days, and over 28 days. Conclusions: In patients of the Groups I and II, pathological hepatic changes in the early stages of mechanical jaundice were manifested in the form of he-patocyte dystrophy and hepatitis development. In the Group I patients, manifestations of steatohepatitis, fibrosis and initial signs of liver cirrhosis were noted in the late stages of subhepatic cholestasis. In addition to the above-mentioned changes, Group II patients, in the late stages of mechanical jaundice, presented signs of severe fibrosis and well-shaped liver cirrhosis. Taking into account the above morphological changes in the liver with different duration of subhepatic cholestasis, we consider reasonable to decompress bile ducts in patients of older age groups at earlier stages of mechanical jaundice compared to young and middle-aged patients, thus preventing post-decompression liver dysfunction and the subsequent development of biliary cirrhosis.

SURGICAL APPROACH FOR TREATMENT OF OBSTRUCTIVE JAUNDICE IN PATIENTS OF DIFFERENT AGE GROUPS

The aim: Assessment of the effectiveness of using minimally invasive and open methods of bile duct decompression for treatment of obstructive jaundice (OJ) by comparing complications in patients of di!erent age groups. Materials and methods: We analyzed the results of surgical treatment of 250 patients with OJ. The patients were assigned to two groups: Group I (n = 100) consisting of young and middle-age patients, and Group II (n = 150) consisting of elderly, senile and long-living patients. The average age was 52 ± 6.0 years. Results: 62 (24.8%) Group I patients and 74 (29.6%) Group II patients were submitted to minimally invasive surgical interventions. 38 (15.2%) Group I patients and 76 (30.4%) Group II patients were submitted to open surgical interventions. Complications after minimally invasive surgery (n = 62) in Group I patients were observed in 2 (3.2%) cases, and in 4 (10.5%) cases after open surgeries (n = 38). Complications following minimally invasive interventions (n = 74) in Group II patients were registered in 5 (6.8%) cases, and in 9 (11.8%) cases following open operations (n = 76). 2 (2.6%) Group II patients died for transmural myocardial infarction. Conclusions: The use of minimally invasive surgical interventions for treatment of young and middle-aged OJ patients compared to patients of older age groups makes it possible to reduce the frequency of complications by 2.1 times, which is a statistically signi"cant (p <0.05). The frequency of complications after open surgical interventions of bile ducts in patients of di!erent age groups is not statistically signi"cant (p >0.05).

Prevalence and Causes of Intrahepatic and Extrahepatic Bile Duct Obstruction among the Jaundiced Patients at Riyadh Hospitals Diagnosed by Ultrasound

The aim of this study was to assess the prevalence and causes of bile duct obstruction among patients with jaundice at the ultrasound departments in Riyadh hospitals. Methods and Results: The study included 525 records of jaundiced patients above 18 years old that were referred to the ultrasound department. Data were collected from PACS (Picture Archiving and Communication System) at three different hospitals in Riyadh. Of 525 adult jaundiced patients, 69 had biliary obstruction, a 13% prevalence. In our study, 38(55.1%) cases of obstruction were caused by stones, 14(20.3%) by tumors, 9(13.0%) by inflammation, 5(7.2%) by a nonfunctioning stent, and 3(4.3%) by pnemobilia. Obstructive jaundice occurred significantly more frequently with increasing age. The study revealed no significant difference between gender and the presence of obstruction. More studies with a larger sample size of obstructive jaundice patients are suggested.

Clinical profile, management, and outcome of obstructive jaundice patient at a tertiary care center: A prospective study

Background: There are various causes of obstructive jaundice, choledocholithiasis is the commonest cause. Patients with obstructive jaundice need early diagnosis to established level and nature of obstruction in biliary system. The history and clinical examination in arriving at a correct pre-operative diagnosis in almost always possible today because of advances in imaging techniques over the decades. Presents study attempts to determine the various causes, age and sex pattern in Extra Hepatic obstructive jaundice. Aims and Objectives: The aim of the study was to study clinical profile, management, and outcome of obstructive jaundice, patient at a tertiary care center: A prospective study. Materials and Methods: The present hospital based prospective interventional study was conducted on patients with obstructive jaundice, those were admitted in the Department of General Surgery at GSVM Medical College Kanpur, patients of age more than 12 years both sex after obtaining the consent form the patient or their relatives were studied during the period of study from January 2020 to October 2021. Results: Of the 50 patients; 29 (58%) were female and 21 (42%) were male, their mean age being 51.10 years. Malignant obstructive jaundice was seen in 19 (38%) patients while 31 (62%) had benign etiology. Amongst the obstructive jaundice cases; pain in abdomen (100%) was commonest symptoms and icterus (100%) was the most common sign. The most common malignancy was Carcinoma (Ca) of the head of pancreas 09 (18%) followed by distal common bile duct (CBD) cholangiocarcinoma 04 (08%), and hilar cholangiocarcinoma 03 (06%). Choledocholithiasis 25 (50%) was the most common benign cause followed by benign stricture of common bile duct 03 (06%). Conclusion: Obstructive jaundice is one of the common causes of surgically amenable jaundice. Its etiology is varied and diagnosis usually depends on appropriate imaging. Proper diagnosis and treatment is necessary as delay in the diagnosis may cause irreversible pathological changes causing increased morbidity and mortality.

Successful endoscopic drainage of malignant obstructive jaundice in patients with situs inversus totalis: Two cases report.

Introduction and importanceAlthough endoscopic techniques in situs inversus totalis (SIT) have been reported, endoscopic retrograde cholangiopancreatography (ERCP) in patients with situs inversus totalis (SIT) remains difficult to every hepatobiliary surgeon. To investigate the differences of each position, ERCP was used to perform through two different body positions.Case presentationHerein we report a 63-year-old woman presented with epigastric pain for 2 months and jaundice for 7 days and a 51-year-old man with presented jaundice for 7 days. Preoperative examination revealed situs inversus totalis and gallbladder carcinoma with diffuse dilatation of the biliary tree. ERCP was used to perform by using two different body positions. In addition, the ERCP combined with percutaneous transhepatic cholangial drainage (PTCD) was performed in the second patient.Clinical discussionThe different endoscopic approaches are used in different positions, the endoscopist should be familiar with mirror symmetrical anatomy. We argue that the prone position has a higher surgical success rate and ERCP combined with PTCD will be easier in SIT patients.ConclusionERCP in SIT patients is generally safe and it will be easier by combining with PTCD.

The effect of obstructive jaundice on the sensitivity of intravenous anesthetic of remimazolam: study protocol for a controlled multicenter trial

BackgroundIt is well known that obstructive jaundice could affect the pharmacodynamics of some anesthetics, and the sensitivity of some anesthetics would increase among icteric patients. Remimazolam is a new ultra-short-acting intravenous benzodiazepine sedative/anesthetic, which is a high-selective and affinity ligand for the benzodiazepine site on the GABAA receptor. However, no study has reported the pharmacodynamics of remimazolam in patients with obstructive jaundice. We hypothesize that obstructive jaundice affects the pharmacodynamics of remimazolam, and the sensitivity of remimazolam increases among icteric patients.Methods/designThe study will be performed as a prospective, controlled, multicenter trial. The study design is a comparison of remimazolam requirements to reach a bispectral index of 50 in patients with obstructive jaundice versus non-jaundiced patients with chronic cholecystitisor intrahepatic bile duct stones. Remimazolam was infused at 6 mg/kg/h until this endpoint was reached.DiscussionRemimazolam could be suitable for anesthesia of patients with obstructive jaundice, because remimazolam is not biotransformed in the liver. Hyperbilirubinemia has been well-described to have toxic effects on the brain, which causes the increasing of sensitivity to some anesthetics, such as desflurane, isoflurane, and etomidate. Furthermore, remimazolam and etomidate have the same mechanism of action when exerting an anesthetic effect. We aim to demonstrate that obstructive jaundice affects the pharmacodynamics of remimazolam, and the dose of remimazolam when administered to patients with obstructive jaundice should be modified.Trial registrationChinese Clinical Trial Registry ChiCTR2100043585. Registered on 23 February 2021

Percutaneous biliary drainage for obstructive jaundice in patients with inoperable, malignant biliary obstruction

Aim of the studyMost of the malignancies leading to obstructive jaundice are diagnosed too late when they are already advanced and inoperable, with palliation being the only treatment option left. Due to progressing hyperbilirubinaemia with its consequent adverse effects, biliary drainage must be established even in advanced malignancies. This study aims to investigate and analyse factors that affect clinical outcomes of percutaneous trans-hepatic biliary drainage (PTBD) in patients with obstructive jaundice due to advanced inoperable malignancy, and identify potential predictors of patient survival. Study design: Observational retrospective cohort study.Material and methodsBaseline variables and clinical outcomes were evaluated in 108 consecutive patients treated with PTBD. The study’s primary endpoints were significant bilirubin level decrease and survival rates. Secondary endpoints included periprocedural major and minor complication rates and catheter primary and secondary patency rates.ResultsPTBD was technically successful and bile ducts were successfully drained in all 108 patients. Median serum bilirubin level, which was 282 (171-376) µmol/l before drainage, decreased significantly, to 80 (56-144) µmol/l, 15 days after stent placement (p < 0.001). Patient survival ranged from 3 to 597 days and the overall (median) survival time following PTBD was 168 days (90-302). The 1, 3, 6, 12 and 18-month survival rates were 96.3%, 75.9%, 48.1%, 8.3% and 1.9%, respectively. Multivariate analysis revealed that liver metastases and alkaline phosphatase were significantly associated with mortality. The overall complication rate was 9.3%.ConclusionsPTBD is a safe and effective method to relieve jaundice caused by advanced inoperable malignant disease. Careful patient selection is necessary when introducing PTBD in order to avoid invasive procedures in patients with a poor prognosis.

Portrait of Microbiology Profile in Obstructive Jaundice Cases: A Single Center Experience

Introduction: Physiologically bile is aseptic, however bacteria may be present in bile in cases of biliary infections. Portrait of biliary microbiology in patients with obstructive jaundice in Indonesia have never been reported before. Methods: Data of obstructive jaundice patients in digestive surgery division, Fatmawati General Hospital were collected prospectively from November 2020 to June 2021. Data collected included age and gender, diagnosis, causes of jaundice, preoperative total and direct bilirubin, preoperative leucocyte and culture results. Bile was aspirated, using a 3cc syringe, directly from the biliary tree above the obstruction and placed into amies transport medium and sent to microbiology laboratory. Results: Bile samples were obtained in 28 out of 39 cases of obstructive jaundice. All samples were obtained during an open surgical procedure without prior intervention. There was equal distribution between male and female female patients with the mean age of 51.8 (± 12.7). The cause of obstructive jaundice were 57% biliary stones and 39% of malignant causes. Positive culture was found in 25% of cases (n=7), the most common pathogen found was Escherichia coli (57%). Fungal infection, candida tropicalis, was found in one case (14%). Conclusion: Although bile is essentially sterile, pathogens can grow in selected cases. The frequency and spectrum of bacteria that infect bile, including their sensitivity to antibiotics are important in guiding patient management. This is a preliminary result from an ongoing study in our centre to determine the best choice of antibiotics given to obstructive jaundice patients.

Alterations of actin cytoskeleton and arterial protein level in patients with obstructive jaundice.

Vascular hypo-responsiveness to vasopressors in patients with obstructive jaundice (OJ) is a common anesthetic event, which leads to perioperative complications and increased mortality. The cause of this clinical issue remains unclear. In this study, we estimated the actin cytoskeleton and arterial protein level in the artery of OJ patients by proteomic analysis. Ten patients with OJ due to bile duct diseases or pancreatic head carcinoma were enrolled, while another ten non-jaundice patients with chronic cholecystitis or liver hemangioma as the control group. Vascular reactivity to noradrenaline was measured before anesthesia on the day of surgery. Artery samples in adjacent tissues of removed tumor were collected and evaluated by 2-dimensional electrophoresis. Proteins with differential expression were detected by MALDI-TOF mass spectrometry with immunoblot confirmation. The results confirmed the phenomenon of vascular hypo-reactivity in OJ patients as suppressed aortic response to noradrenaline were existed in these patients. We also found that actin cytoskeleton and several actin-binding proteins were up- or down-regulated in the artery of OJ patients. These proteins changed in OJ patents might be the basic mechanism of vascular hypo-reactivity, further studies to uncover the role of these proteins in OJ is critical for clinical treatment of these patients.

Clinical Characteristics, Treatment, and Prognosis of Patients with Obstructive Jaundice in Tertiary Care Facilities: A Prospective Study

Background: Obstructive jaundice can have a number of reasons, but choledocholithias is the most frequent. Obstructive jaundice patients frequently complain of pruritus, jaundice, pale faeces, dark urine, and yellow skin and eyes. Today, because to improvements in imaging technology over the years, a precise pre-operative diagnosis is nearly always attainable. The study's goals were to examine the clinical characteristics and treatment of patients with obstructive jaundice. Methods: Patients with obstructive jaundice who were admitted to the Department of Hepatology at SCB Medical College, Cuttack, Odisha, were the subject of the current hospital-based prospective interventional study. Patients of age greater than 12 years of either sex were studied during the study period of two years after providing written consent. Results: The mean age of the 50 patients was 51.10 years, with 29 (58%) female and 21 (42%) male patients. 19 (38%) of the patients had malignant obstructive jaundice, while 31 (62%) had benign causes. The most frequent symptoms and signs of obstructive jaundice were abdominal pain (100%) and icterus (100%) respectively. The most frequent cancer was cholangiocarcinoma (Ca) of the head of pancreas (Ca) of 2009 (18%), followed by cholangiocarcinoma of the distal common bile duct (CBD) of 2004 (08%), and hilar cholangiocarcinoma of 2003 (06%). The most frequent benign cause was choledocholithiasis 25 (50%) followed by benign stricture of common bile duct 03 (06%). Conclusion: One of the frequent reasons of surgically treatable jaundice is obstructive jaundice. Its cause is diverse, and the right imaging is typically required for diagnosis. As delayed diagnosis may result in permanent pathological alterations that increase morbidity and death, proper diagnosis and treatment are essential.

Efficacy of Chymotrypsin in the Prevention of Postendoscopicretrograde Cholangiopancreatography Pancreatitis

Introduction: Pancreatitis is common after endoscopic retrograde cholangiopancreatography (ERCP).To assess the pharmacological effect of diclofenac, allopurinol and chymotrypsin in the prevention of post ERCP pancreatitis (PEP). Calcular obstructive jaundice patients without pancreatitis scheduled for ERCP were randomized into three groups. Methods: The diclofenac group received 200mg rectal suppositories immediately after ERCP, allopurinol received oral 300mg 3 h before ERCP, and chymotrypsin received intramuscular injection immediately after ERCP. Serum amylase and lipase were measured before, 1, 6, and 24 h after ERCP and procedure-related risk factors for post-ERCP pancreatitis were recorded. Pancreatitis was considered when serum amylase or lipase levels elevated more than three times the upper limit of normal with newly developed abdominal pain lasting at least 24 h after ERCP. Results: 150 patients were included; diclofenac group (58 patients, 29 men, mean age 46.9±13.2 years), allopurinol (38 patients, 20 men, mean age 43.1±14.7 years) and chymotrypsin (54 patients, 28 men, mean age 40.6±17.3 years). 12 (8%) patients developed PEP: the diclofenac group (n=4; 6.9%), allopurinol (n=6; 15.8%) while chymotrypsin (n=2; 3.7%), but this was not statistically significant (P=0.318). In patients who received chymotrypsin, regression of serum amylase and lipase to normal levels was much better compared with the other groups and was associated with better clinical improvement. Conclusion: Chymotrypsin and allopurinol are comparable to diclofenac in the prevention of pancreatitis post-ERCP. Beside its prophylactic role, chymotrypsin could be effective in rapid improvement if PEP occurs.

A surgeon's perspective on the clinical picture of patients with obstructive jaundice

Background: Obstructive jaundice can have a number of reasons, the most prevalent of which being choledocholithiasis. Obstructive jaundice patients frequently complain of pruritus, jaundice, pale faeces, dark urine, and yellow skin and eyes. Diagnosis is frequently muddled by abdominal pain. The study's goals were to examine the clinical characteristics of people with obstructive jaundice. Methods: A prospective research was done at SCB Medical College, Cuttack, Odisha. The study period of this research was three years. In the study, 30 patients made up the sample. All patients who are admitted and are found to have an obstructive pattern of jaundice meet the inclusion criteria. Results: CBD calculi are the most typical cause of postoperative jaundice. Jaundice is the most typical presenting symptom, followed by appetite loss and weight loss. The most frequent symptoms of benign causes are abdominal discomfort and jaundice. Conclusion: The clinical profile of patients with obstructive jaundice can be better understood to enable optimal care and enhance survival.

Prevention of post-ERCP pancreatitis using pancreatic duct stenting in difficult cannulation patients with calcular biliary bbstruction

Background: Post-ERCP pancreatitis (PEP) has been the most frequent complication of Endoscopic Retrograde Cholangiopancreatography (ERCP). It has been documented to happen after 5–30% of ERCP procedures. PEP is new or exacerbated abdominal pain associated with a serum lipase or amylase concentration which is more than three times the upper limit of normal at 24 hours post-ERCP, requiring at least two days of prolongation of the planned admission. Following pancreatic sphincterotomy, pancreatic stenting is commonly used with the objective of decreasing both early restenosis and post-ERCP pancreatitis. Aim of the work: Evaluation of the pancreatic stenting technique as a preventive measure against post ERCP pancreatitis in calcular obstructive jaundice patients with difficult cannulation. Patients and methods: Forty Egyptian patients with calcular biliary obstruction with a difficult biliary cannulation who are at risk of developing PEP enrolled in a prospective randomized controlled comparative study. Group A: 20 patients with manipulation of pancreatic duct by guidewire without pancreatic stent insertion; Group B: 20 patients with manipulation of pancreatic duct by guidewire with pancreatic stent insertion.Results: The pancreatic duct stenting technique had reduced the risk of PEP significantly in calcular biliary obstruction patients with difficult CBD cannulation to 20?% (in group B) compared with 60?% in (group A).Conclusion: Prophylactic pancreatic stenting technique is a simple and easy procedure that showed to be efficient in decreasing cases of post ERCP pancreatitis in difficult cannulation patients. The endoscopists should be trained to practice the procedure safely.

Effect of Age and Gender on Quality of Life in patients of Obstructive Jaundice

Aim: Effect of age and gender on quality of life in patients of obstructive jaundice. Methodology: This was a case control study conducted in OPD of General Surgery, Unit-1, Civil Hospital, Karachi. It is non-probability, consecutive sampling technique. The sample size was 195 subjects. 87 patients had an age between 18-60 years whereas 108 patients had &gt;60 years of age. Either gender was included. QoL was measured by using SF-36 based on 8 domains. Data were analyzed through SPSS version-21 Results: Significant effect of age in obstructive jaundice patients on their QOL (p&lt;0.01) where patients aged from 18 to 60 years had significantly higher SF-36 quality of life scores, both overall and in all eight individual domains than patients aged &gt;60 years. Gender of the obstructive jaundice patients did not have a significant effect on their QOL, though the female patients had higher SF-36 quality of life scores, both overall and in all eight individual domains. Conclusion: Quality of life of obstructive jaundice patients were more improved with the age between 20-60 years than age &gt;60 years, whereas gender had no significant impact on the quality of life. Keywords: Obstructive jaundice, age, gender, quality of life