Obstructive Jaundice Research Articles

Laparoscopic Cholecystectomy Under Combined Spinal and Epidural Anesthesia in the First Trimester of Pregnancy—Case Report and Literature Review

Can combined spinal and epidural anesthesia be the gold standard for laparoscopic surgery for pregnant patients? This case report presents a first trimester pregnant patient who was admitted for obstructive jaundice syndrome (pain in the right hypochondrium, nausea, and vomiting). Initially, because of the risk/benefit ratio of pregnancy, the treatment was medical and the patient was immediately discharged because her clinical condition improved, but she was rapidly readmitted to the surgery department because of worsening symptoms. Emergency surgical intervention (laparoscopic cholecystectomy) under combined spinal and epidural anesthesia (CSEA) was performed to reduce the patient’s risks. Since most analgesics are insufficiently studied in pregnancy, analgesia with ropivacaine 0.2% was used on the epidural catheter. No pathological changes were identified in the fetal Doppler ultrasound preoperatively and postoperatively. Similarly to other studies, our case highlights the necessity for cholecystectomy for acute cholecystitis even if the patient is in the first trimester of pregnancy. If the decision is delayed, the morbidity and mortality for mother and fetus become unjustified. The peculiarity of the present report is the type of anesthesia chosen. We consider that combined spinal and epidural anesthesia may become a possible gold standard suitable for laparoscopy in the first trimester of pregnancy.

Possibilities of Peroral Transpapillary Cholangioscopy in Treatment of Complex Choledocholithiasis

Background: Сomplex choledocholithiasis remains an urgent socio-medical problem in modern medicine. This pathology is more common in patients with cholelithiasis and causes such complications as obstructive jaundice, acute and chronic pancreatitis, cholangitis, etc. Effective treatment depends on proper preoperative examination, which is quite challenging. In such cases, minimally invasive diagnostic methods play a fundamental role. Endoscopic cholangioscopy is an effective and highly informative method for diagnosis and treatment of biliary diseases including сomplex choledocholithiasis; in many cases it is the only examination technique that allows for a reliable diagnosis. The effectiveness of this technique and possibilities of its implementation by leading specialists in the Russian Federation and around the world remain important issues.Objective: To summarize available literature data on possibilities of using cholangioscopy in diagnosis and treatment of сomplex choledocholithiasis.Materials and methods: We conducted a literature review using PubMed and eLIBRARY. Our goal was to cover the most up-to-date medical articles published on the subject in the past 10 years. Studies included in our review are based on experimental and clinical data. Thus, we obtained the most reliable results that can be used in further research and practice.Results: We found that cholangioscopy has significant clinical value, which confirms its role as an important diagnostic and therapeutic approach in addition to endoscopic retrograde cholangiopancreatography in treatment of complex choledocholithiasis. This technique should be further thoroughly studied.

BN O02 - Introducing the Cholecystectomy Urgency Index (CUI) – A novel way to visualise and optimise the waiting list for laparoscopic cholecystectomy at a large district general hospital

Abstract Background Gallstone disease effects approximately 10-15% of the adult population, and laparoscopic cholecystectomy is one of the most common surgical procedures in the UK, with over 60,000 performed each year. Delays to surgery from diagnosis has been found to increase patient morbidity and readmission rate. Waiting lists in the UK have been struck with a significant backlog from the COVID-19 pandemic, and navigating this ever-expanding patient population to determine priority for booking cases is complex. We propose a new system to prioritise and visualise this cohort of patients in real time – the Cholecystectomy Urgency Index. Method At one large district general hospital, we had a waiting list of 148 patients for laparoscopic cholecystectomy. We identified the individual underlying pathology and established the waiting time since diagnosis to allocation of operative date. We used excel to formulate a pairwise scatter plot of the waiting list patients based upon the time waiting. We were able then to colour code them based on pathology (biliary colic/cholecystitis/cholangitis/pancreatitis/obstructive jaundice). We were then able to link this directly to our scheduling to create a live, visual representation of our waiting list, by both days waited and causative pathology. Results We found our median wait times for patients varied based on pathology: Biliary Colic = 185 days, Cholecystitis = 57 days, Pancreatitis, Cholangitis and Obstructive Jaundice (OJ) = 65 days. We found that the pairwise scatter plot provided a rapidly accessible, easily identifiable visual representation of our patient cohort by both days waited and diagnosis. This allows relevant staff, surgeons and schedulers to plan elective cases according to both urgency and time waited. Long waiters are easily identified as outliers on the graph and can therefore be flagged for last minute cancellation slots. Conclusion By using this system, we can optimise our waiting lists, improve productivity and patient outcomes. We propose a system to enable this further when booking patients: to give them a colour coded CUI number of 1-3. 1 being biliary colic, 2 – cholecystitis, 3 – pancreatitis/cholangitis/OJ. This will be directly linked to our scatter graph and in doing so, provides us with a readily available, live snapshot in time of the current wait list. This system allows for both clinical urgency prioritisation and easy visualisation of patient cohorts, thus catalysing the elimination of long waiters by means of clear identification.

Clinical Results of Percutaneous Transhepatic Biliary Drainage With Different Hepatic Access and Methods in the Treatment of Obstructive Jaundice.

Percutaneous transhepatic biliary drainage (PTBD) is a common procedure for biliary obstruction jaundice caused by biliary tract obstruction. PTBD can be performed using external or external-internal methods, by the right or left lobe approach. However, differences in both the method used and the hepatic approach may affect success rates and complications. Therefore, this study aimed to examine the outcomes and complications of PTBD and compare them according to different methods and hepatic approaches. Patients who underwent PTBD procedures in our interventional radiology department due to benign or malignant pathologies between March 2021 and March 2024 were included in the study. The diagnoses of the patients, and total and direct bilirubin values before and after the procedure were recorded. The clinical results and the complications of PTBD were compared statistically according to the hepatic approach and method. Univariate logistic regression analysis was performed to determine significant factors associated with PTBD success and complications. Sixty patients were included in our study (32 men, 28 women; mean age: 67.14±13.61y). The most common indication was malignant bile duct obstruction (90%). The obstruction was mostly at the level of the common bile duct (46.7%). The success rate of PTBD was the highest with the left-side external biliary drainage approach (left-side external biliary drainage, 81.2%; right-side internal-external biliary drainage, 77.8%; right-side external biliary drainage, 69.2%; P=0.596). The complication rate was higher for right-side access (right side 15.9%, left side 12.5%, P=0.744). Univariate logistic regression analysis revealed that PTBD success in females was 5 times higher than in males [Exp(B): 5.000, β: 1.609, P<0.05]. Univariate logistic regression analysis revealed that methods used, entry lobes, and entry levels did not significantly affect PTBD success and complication incidence (P>0.05). All approaches and methods used during PTBD were associated with low complications and high success rates. Nevertheless, external biliary drainage with right hepatic access has the lowest clinical success rate and a higher complication rate than the left-lobe approach. We observed that left-sided external biliary drainage was the most successful method and had fewer complications.

Impact of biliary-pancreatic double stents on EUS-guided tissue acquisition among patients with solid pancreatic lesions: A multicenter study

ABSTRACT Background and Objective Although the impact of biliary stents on the accuracy of EUS-guided tissue acquisition (EUS-TA) is still controversial, the influence of biliary-pancreatic double stents on EUS-TA is even more inconclusive. The aim of the study was to determine whether the diagnostic yield of EUS-FNA in the diagnosis of solid pancreatic lesions will be affected after placement of biliary-pancreatic double stents. Methods A multicenter retrospective study including patients who underwent EUS-FNA with biliary duct obstruction was performed. Patients were divided into 2 groups according to whether there were biliary-pancreatic double stents before EUS-FNA. The patients' EUS-FNA report, histopathological results, and clinical case data were reviewed and compared. Results Ninety-two patients were included, 42 with biliary-pancreatic double stents and 50 without any stents. The puncture time taken by EUS-FNA was significantly longer in the stent group than the no-stent group (19 vs. 15 min, P &lt; 0.001). No significant differences were observed in accuracy (90.5% vs. 94%), sensitivity (89.5% vs. 93.6%), specificity (100% vs. 100%), NPV (50% vs. 50%), PPV (100% vs. 100%), respectively, in both groups. Patients with larger lesions (OR = 1.600, 95% CI: 1.124–2.277) and those who required more passes had a higher diagnostic yield (OR = 9.376, 95% CI: 1.356–64.819) by multivariate analysis. Conclusions ERCP before EUS-FNA is feasible for the treatment of solid pancreatic lesions causing obstructive jaundice. It will not have a negative impact on the diagnostic accuracy and surgical complications, but the EUS-FNA operation time will be prolonged.

Ultrasonography (USG) Evaluation among Patients with Biliary Obstruction in a Tertiary Care Center

Background: Biliary obstruction is a blockage in the bile ducts that prevents bile from flowing from the liver to the small intestine. Objectives: This study aimed to assess the efficacy of ultrasonography (USG) among patients with a blockage in the bile ducts as known as biliary obstruction. Methods: This was a prospective observational study conducted at the Department of Radiology and Imaging at Sir Salimulliah Medical College Hospital, Dhaka, Bangladesh. This study included patients with clinical suspicion of biliary obstruction who underwent USG. Characteristics of the obstruction were evaluated for both benign and malignant lesions through USG. The findings were then correlated with ERCP, histopathology, or surgery to calculate the diagnostic performance of the former two modalities. Results: Out of 145 patients, 63 were in the malignant group and 82 were in the benign group. The sensitivity, specificity, and accuracy of detecting the nature of obstruction by USG were 33%, 84%, and 48.9%, respectively. The overall diagnostic accuracy of USG in predicting the site of obstruction was 64.3%. Hydatid Cyst and the Main Pancreatic Duct Stricture were the most accurate findings of USG. Conclusions: USG should be the initial screening modality of choice for predicting the level and nature of obstruction in patients with a clinical suspicion of obstructive jaundice.

A Composite Index for Distinguishing Benign and Malignant Obstructive Jaundice.

To explore a more effective and practical comprehensive index for differentiating benign from malignant obstructive jaundice by analyzing the clinical data of patients with benign obstructive jaundice (BJ) group and malignant obstructive jaundice (MJ) group. A retrospective analysis was conducted on the clinical data of 339 patients with obstructive jaundice. The cases were divided into two data sets: training cohort and validation cohort. The cases were divided into two groups: malignant and benign obstructive jaundice group. Logistic regression analysis was used to build a prediction model for judging the nature of obstructive jaundice, and the prediction model was verified using the validation cohort. Multivariate analysis revealed that CEA, TBIL, and NLR were independent factors in malignant obstructive jaundice. A comprehensive index for differentiating benign from malignant obstructive jaundice was established based on these indicators. The sensitivity, specificity, and receiver operating characteristic curve of this model for differentiating benign from malignant obstructive jaundice were 79.57%, 93.26%, and 0.920, respectively. The prediction model based on the comprehensive index of CEA, TBIL, and NLR has a higher accuracy in differentiating malignant obstructive jaundice.

Clinical characteristics, imaging diagnostic accuracy, and prognosis of autoimmune pancreatitis: A real-world study in China.

In this study we aimed to comprehensively evaluate the clinical features and treatment outcomes of Chinese patients with autoimmune pancreatitis (AIP) through a single-center real-world study. Patients diagnosed with AIP in Changhai Hospital, Naval Medical University from January 2014 to December 2021 were included. Baseline characteristics, laboratory test results, cross-sectional imaging and endoscopic ultrasound (EUS) findings, and long-term follow-up data were obtained. The differences in these characteristics between type 1 and type 2 AIP patients were analyzed. Among all 320 patients, 271 (84.7%) and 49 (15.3%) had type 1 and type 2 AIP, respectively. The most common initial symptom was abdominal discomfort (58.1%), followed by obstructive jaundice (32.5%). Extrapancreatic organ involvement was identified in 126 (39.4%) patients, with the biliary system being the most commonly involved (36.6%). Elevated serum IgG4 level was rare in type 2 AIP patients. The diagnostic accuracy of computed tomography (CT), magnetic resonance imaging (MRI), and EUS for definitive and probable AIP were 78.0%, 68.7%, and 80.5%, respectively. EUS-guided tissue acquisition with immunohistochemical staining helped establish a final diagnosis in 39.7% of patients. During the follow-up period of 60 months, 18.6% of patients experienced relapse. The 1-, 3-, and 5-year relapse rates were higher in type 1 AIP patients, with an accumulated rate of 8.0%, 12.6%, and 15.1%, when compared with those with type 2 AIP. Type 2 AIP is not uncommon in Chinese population. The diagnostic accuracy of CT and EUS for AIP might be superior to that of MRI.

Changes over time in treatment for obstructive jaundice

Changes over time in treatment for obstructive jaundice

Safety and efficacy of using stapler device for wide cystic duct ligation in acute setting of laparoscopic cholecystectomy

This research explores the challenges posed by variations in cystic duct anatomy during laparoscopic cholecystectomy and the potential use of stapler devices to address such complexities. It aims to assess the safety and efficacy of stapler devices, particularly in cases involving short, and wide cystic duct. The study, conducted at King Abdulaziz Medical City in Riyadh, Saudi Arabia, between 2021 and 2023. The study design involved a retrospective cohort approach, and the sample size encompassed all cases meeting the inclusion criteria during the study period. Data was analyzed using SPSS program. The study involving 568 patients, with the predominant technique for ligation being clipping (89.3%). The primary indication for using the Endo GIA stapler was a wide cystic duct (6.2%). Analysis revealed a significant association between stapler device use and hypertension (p = 0.042), diabetes (p = 0.001), CKD (p = 0.011), and obstructive jaundice (p = 0.006). Multivariate regression demonstrated that older patients were 2.1 times more likely to use stapler devices (AOR = 2.125; p = 0.039), while those with obstructive jaundice had a 2.2 times higher likelihood (AOR = 2.168; p = 0.049). Throughout the years, metal clips have shown the best prognosis compared to any other method for securing the cystic duct during closure in laparoscopic cholecystectomy. However, to avoid incomplete sealing of wide, short, or inflamed ducts, other instruments have emerged as possible alternatives for such conditions. Use of Endo-GIA is a safe and effective method for patients with wide, short cystic duct. Selective usage of endo-GIA is considered cost effective and may add a positive impact in decreasing post operative biliary leak.

Impact of Retroperitoneal Lymphadenopathy (RPLN) on the Outcomes of Locally Advanced Gall Bladder Cancer (GBC) Following Chemotherapy (CT) or Chemotherapy Followed by Consolidation Chemoradiotherapy (CTRT).

Retroperitoneal lymphadenopathy is considered a metastatic disease in GBC; however, some surgical series of radical surgery with enlarged RPLN who underwent RPLN dissection have shown results marginally inferior to those without enlarged RPLN. Radiological RPLN comprises a major proportion of advanced non-metastatic GBC. There is dilemma in the intent of treatment to be offered in such cases. We are reporting our series of outcome of GBC with RPLN treated with first-line CT followed by consolidation CTRT. Non-metastatic locally advanced GBC with good performance status (KPS ≥ 80) were initiated on first-line CT (cisplatin-gemcitabine), and thereafter, responders were evaluated by CECT-angiography and PET-CT scan for resectability. If found unresectable, they were offered consolidation CTRT to a dose of 45Gy by conventional fractionation (3D-CRT technique) along with concurrent capecitabine at 1250mg/m2 to GBC and regional lymphatics including RPLN. Thereafter, boost dose of 9Gy/5# was given to GBC only. Response assessment was done using CECT abdomen by RECIST criteria v 1.1. Outcomes (overall survival) of the two groups (RPLN vs non-RPLN) were computed with Kaplan-Meier survival curves and chi-square tests using SPSS v 20. Among 189 patients of advanced non-metastatic GBC recruited from 2011 to 2022, 80 had RPLN. The demographic features of both groups were comparable. Overall, 68% of the patients were women, 30% underwent upfront stenting for obstructive jaundice, and 90% had T3 and T4 disease. Only 10% had undergone upfront laparoscopic staging and had pathologically proven RPLN. Forty percent of the patients received four cycles of CT only and 50% of the patients received six cycles or more and 33% received CTRT. By RECIST criteria, 10% vs 16% achieved complete response (CR), 39% vs 41% achieved partial response (PR), 16% vs 15% achieved stable disease (SD), 2.7% vs 6% had disease progression (PD), and 14.5% vs 3.7% were non-evaluable in non-RPLN group vs RPLN group, respectively. 12% vs 6% could undergo radical surgery in non-RPLN group vs RPLN group (p = 0.03). The median OS was 9months (95% CI 7.6-10.3months) vs 10months (95% CI 8-9.8months) (p = NS) in non-RPLN group vs RPLN group, respectively. In those who received CT only, the median OS was 7months vs 8months, while in those who received CT followed by CTRT, the median OS was 14months vs 13months (p = 0.65) in non-RPLN group vs RPLN group, respectively. Based on this analysis, we conclude that RPLN constitutes a major proportion of advanced non-metastatic GBC and has outcomes similar to those without RPLN if treated with radical intent. RPLN should not be considered a metastatic disease and should be treated with radical intent.

Gallbladder Polyps: A Literature Review of Basic Concepts, Diagnosis and Treatment Options

Gallbladder polyps (GP) are projections of the mucosa toward the light, most of them are benign caused by cholesterol deposits, focal adenomatosis, or hyperplastic lesions secondary to a local infection. It has an estimated prevalence of 5% of the world population. Cholesterol polyps are usually formed by an asymptomatic process, rarely obstructive jaundice or cholangitis due to the blockage of distal bile ducts by detached fragments of polyps. A small number of patients may be symptomatic; cholesterolosis and adenomatosis can also cause chronic dyspeptic abdominal pain, nausea, and vomiting. Ultrasound is the main imaging modality to diagnose polyps of the gallbladder, endoscopic ultrasonography can be a useful tool in patients with clinical pictures suggestive of vesicular pathology and non-invasive imaging studies, and inconclusive. In a patient aged less than 50 years with GP, the likelihood of malignancy is minimal and does not require cholecystectomy. However, those with a size greater than or equal to 10 mm should be resected by cholecystectomy for high risk of malignancy, and those with a size less than 10 mm should be submitted to ultrasound monitoring, observing the risk characteristics during follow-up, to provide timely treatment.

A Complex Case of Extrahepatic Biliary Obstruction: Syphilitic abdominal lymphadenitis

Abstract Introduction/Objective Syphilis, a sexually transmitted disease that is caused by spirochete Treponema pallidum, can vary widely in presentation. Infective lymphadenitis due to syphilis have been reported before in cervical and inguinal lymph nodes.Here we present an interesting case of syphilitic lymphadenitis with unusual presentation and location. Methods/Case Report A 30-year-old male with no past medical history presented with epigastric pain, fever, jaundice, weight loss, and night sweats. Computed tomography imaging revealed a 4.1 cm solid mass at the porta hepatis with involvement of perihepatic lymph nodes, raising suspicion of malignancy. All serological tumor markers were negative. The patient underwent ERCP with biliary drainage to relieve obstructive jaundice. Bile duct brushing and liver biopsy at that time were non-diagnostic. Later the patient underwent laparoscopic lymph node excision. Histological examination of the lymph node showed intact follicular architecture with an increase in plasma cells and sinus histiocytes, without evidence of carcinoma or lymphoma cells. Flow cytometry on the lymph node showed polytypic B-cells and antigenically normal T-cells with CD4: CD8 ratio of 0.5 showing relatively excess of CD8 positive cytotoxic cells. Positive staining for Treponema pallidum with appropriate control highlighted micro-organisms suggestive of secondary syphilitic infection. This evidence was later supported by positive rapid plasma reagin (RPR) test. He subsequently tested positive for Human immunodeficiency virus (HIV-1). Results (if a Case Study enter NA) NA Conclusion In summary, appropriate histologic and serological testing lead to timely diagnosis in this case. This case contributes to the limited literature on syphilitic lymphadenitis and reports the first documented case of isolated intra- abdominal lymph node involvement.

Therapeutic and Diagnostic Algorithm for Patients with Obstructive Jaundice Based on the Estimation of the Optical Characteristics of the Liver and Bile

Therapeutic and Diagnostic Algorithm for Patients with Obstructive Jaundice Based on the Estimation of the Optical Characteristics of the Liver and Bile

Analysis of the efficacy of Percutaneous Transhepatic Cholangiography Drainage (PTCD) and Endoscopic Retrograde Cholangiopancreatography (ERCP) in the treatment of Malignant Obstructive Jaundice (MOJ) in palliative drainage and preoperative biliary drainage: a single-center retrospective study

PurposeThis study aimed to assess the safety and efficacy of percutaneous transhepatic cholangiography drainage (PTCD) and endoscopic retrograde cholangiopancreatography (ERCP) in palliative drainage and preoperative biliary drainage for treating malignant obstructive jaundice (MOJ).MethodsA total of 520 patients with MOJ who underwent PTCD or ERCP were enrolled and classified into palliative drainage group and preoperative biliary drainage group. Baseline characteristics, liver function, blood routine, complications were compared among the groups.ResultsThe technical success rates for PTCD and ERCP in palliative group were 97.1% and 85.9%. In palliative drainage group, PTCD had higher levels of total bilirubin (TB) reduction (53.0 (30.0,97.0) vs. 36.8 (17.9,65.0), p < 0.001) and direct bilirubin (DB) reduction (42.0 (22.0,78.5) vs. 28.0 (12.0,50.8), p = 0.001) than ERCP. However, PTCD was associated with higher rates of drainage tube displacement (20 cases, 11.8%), while ERCP had a higher incidence of biliary infection (39 cases, 22.8%) and pancreatitis (7 cases, 4.1%). In preoperative drainage group, PTCD achieved a 50% reduction in total bilirubin faster than ERCP (7.1 days vs. 10.5 days). And the time from palliation of jaundice to surgery was 24.2 days in PTCD group and 35.7 days in ERCP group, a statistically significant difference (Student’s t test, p = 0.017).ConclusionBoth PTCD and ERCP could improve liver function for MOJ patients. PTCD seems to offer better outcomes in jaundice reduction and liver function improvement in palliative drainage, but requires careful postoperative management. In preoperative biliary drainage, PTCD may be a better preoperative bridge to improve liver function and control infection.

MUC17 is a potential new prognostic biomarker and promotes pancreatic cancer progression in obstructive jaundice.

Our working group has previously shown that bile acids (BAs) accelerate carcinogenic processes in pancreatic cancer (PC) in which mucin 4 (MUC4) expression has a central role. However, the role of other mucins in PC are less clear, especially in bile-induced cancer progression. The study aim was to investigate expression of MUC17 in BAs- or human serum-treated pancreatic ductal adenocarcinoma (PDAC) cell lines and use different assays with RNA silencing/overexpression to study the role of MUC17 in cancer progression. Protein expression of MUC17 was evaluated in 55 human pancreatic samples by immunohistochemistry, and Kaplan-Meier survival analysis was used to compare survival curves. Expression of MUC17 increased in PDAC patients, especially in obstructive jaundice (OJ) and the elevated MUC17 expression associated with poorer overall survival (10.66±1.99 vs. 15.05±2.03 months; Log rank: 0.0497). Treatment of Capan-1 and AsPC-1 cells with BAs or with human serum obtained from PDAC + OJ patients enhanced the expression of MUC17, as well as the proliferative potential of the cells, whereas knockdown of MUC17 alone or in combination with MUC4 decreased BAs-induced carcinogenic processes. Our results demonstrated that MUC17 has a central role in bile-induced PC progression, and in addition to MUC4, this isoform also can be used as a novel prognostic biomarker.

Endoscopic biliary drainage using a narrow-diameter endoscope in a patient with obstructive jaundice and pancreatic cancer.

Endoscopic biliary drainage using a narrow-diameter endoscope in a patient with obstructive jaundice and pancreatic cancer.

Efficacy Analysis of PTCD + TACE vs PTCD + Apatinib in the Treatment of HCC with Obstructive Jaundice: A Retrospective Study.

The aim was to evaluate the safety and effectiveness of PTCD combined with TACE in the treatment of hepatocellular carcinoma with obstructive jaundice and to compare the efficacy of TACE in patients with different levels of bilirubin after PTCD. The clinical data of 141 patients with HCC complicated with obstructive jaundice were analyzed retrospectively. The patients underwent PTCD first. When the total bilirubin decreased, the patients received TACE or Apatinib treatment. They were divided into two groups: (1) PTCD+TACE group, N=68; (2) PTCD+Apatinib group, N=73. The PTCD+TACE group had higher ORR and DCR than the PTCD+Apatinib group (57.4% vs 12.3%, p < 0.001;80.9% vs 60.3%, p = 0.010). The mPFS of the PTCD+TACE group was longer than that of the PTCD+Apatinib group (7.1 months vs 3.8 months, p < 0.001). The mOS of the PTCD+TACE group was longer than that of the PTCD+Apatinib group(11.5 months vs 7.7 months, p < 0.001). In the subgroup analysis of the PTCD+TACE group, the results showed that the survival benefits of the groups with total bilirubin <2 times and 2-3 times were greater. In patients with HCC and obstructive jaundice, superselective TACE(lipiodol+epirubicin emulsion) significantly prolonged OS and PFS compared with Apatinib after using PTCD to reduce total bilirubin to <100umol/L. Patients whose total bilirubin dropped to ≤3 times of the upper limit of normal value after PTCD had longer OS and PFS than patients >3 times.

Effectiveness of endoscopic ultrasound-guided biliary drainage in patients experiencing obstructive jaundice due to unsuccessful endoscopic retrograde cholangiopancreatography

Objective: To assess the treatment outcomes of endoscopic ultrasound-guided biliary drainage (EUS-BD) in patients with obstructive jaundice due to unsuccessful endoscopic retrograde cholangiopancreatography (ERCP). Methods: The clinical data of patients with obstructive jaundice who underwent EUS-BD due to ERCP failure at the Gastrointestinal Endoscopy Center of Beijing Friendship Hospital from September 2018 to November 2023, was retrospectively collected and analyzed. We explored the technical success, clinical success, and adverse events associated with EUS-BD. Results: In total, 43 EUS-BD procedures were performed in 39 patients with a technical success rate of 86.0% (37/43). The clinical success rate was 81.1% (30/37). Biliary drainage was not effectively achieved in seven cases, including two fatal cases and five cases of recurrent postoperative biliary obstruction. The incidence of adverse events was 21.6% (8/37), including two cases of postoperative bile leakage peritonitis, two cases of stent displacement, one case of stent dislocation, one case of perforation, and two cases of death. Conclusion: EUS-BD is a relatively safe and effective method for bile duct drainage, serving as a dependable alternative therapeutic option for patients with obstructive jaundice due to unsuccessful ERCP.

S2675 Pancreatitis and Obstructive Jaundice as Presenting Symptoms for Ampullary Pancreatic Neuroendocrine Tumor

S2675 Pancreatitis and Obstructive Jaundice as Presenting Symptoms for Ampullary Pancreatic Neuroendocrine Tumor