Treatment Of Obstructive Jaundice Research Articles

Deconvolution of the fluorescence spectra measured through a needle probe to assess the functional state of the liver.

Currently, one of the most pressing issues for surgeons in the treatment of obstructive jaundice is the ability to assess the functional state of the liver and to detect and determine the degree of liver failure in a timely manner with simple and objective techniques. In this regard, the use of fluorescence spectroscopy method can be considered as one of the ways to improve the informativity of existing diagnostic algorithms in clinical practice and to introduce new diagnostic tools. Thus, the aim of the work was to study in vivo the functional state of liver parenchyma by the method of fluorescence spectroscopy implemented through a needle probe and assess the contribution of the main tissue fluorophores to reveal new diagnostic criteria. We compared data from 20 patients diagnosed with obstructive jaundice and 11 patients without this syndrome. Measurements were performed using a fluorescence spectroscopy method at excitation wavelengths of 365 and 450 nm. Data were collected using a 1 mm fiber optic needle probe. The analysis was based on the comparison of the results of deconvolution with the combinations of Gaussian curves reflecting the contribution of the pure fluorophores in the liver tissues. The results showed a statistically significant increase in the contribution of curves reflecting NAD(P)H fluorescence, bilirubin, and flavins in the group of patients with obstructive jaundice. This and the calculated redox ratio values indicated that the energy metabolism of the hepatocytes may have shifted to glycolysis due to hypoxia. An increase in vitamin A fluorescence was also observed. It may also serve as a marker of liver damage, indicating impaired vitamin A mobilization from the liver due to cholestasis. The results obtained reflect changes associated with shifts in the content of the main fluorophores characterizing hepatocyte dysfunction caused by accumulation of bilirubin and bile acids and after disturbance of oxygen utilization. The contributions of NAD(P)H, flavins, and bilirubin as well as vitamin A can be used for further studies as promising diagnostic and prognostic markers for the course of liver failure. Further work will include collecting fluorescence spectroscopy data in patients with different clinical effects of obstructive jaundice on postoperative clinical outcome after biliary decompression.

Limitations and Success Ratio of ERCP in the Treatment of Obstructive Jaundice

Background: Obstructive jaundice can be instigated by benign or malignant lesions. These problems are treated with biliary decompression, which can be done either endoscopically or surgically. Aim: The aim of the study is to assess the advantages and limitations as well as the therapeutic and diagnostic benefits of ERCP in the treatment of obstructive jaundice. Methods: This cross-sectional study was held in the Departments of General Surgery, Liaquat University of Medical and Health Science, Jamshoro for one-year duration from January 2022 to December 2022. A total of 70 consecutive patients were included with purposive sampling and with the diagnosis of obstructive jaundice done with ERCP. Patients with prior diagnostic or therapeutic endoscopic intervention or gastric outlet obstruction or prior gastric surgery were excluded from this study. The results are summarized in a table and conclusions are made. Results: The study included 70 patients (45 males and 25 females) with mean age of 45 years (21-70 years). The most common malignant causes of obstructive jaundice are papillary carcinoma (8.6%), cholangiocarcinoma (17.1%) and pancreatic Carcinoma (27.1%). The most common benign cause was bile duct stone (30%), followed by round warm biliary tree (5.8%) and papillary stenosis (11.4%). 30(93.8%) of patients done with stenting with 92% of success rate. Biopsies were performed to diagnose 8.6% of papillary tumors. 45.7% of patients done with stenting with 93.8% of success rate. In the remaining cases, the success rate was 100%. the most common reason for not performing ERCP; duodenal stenosis in 2.9%, abnormal papillary position in 4.3%, complete papillary obstruction in 4.3% and ampulla was not found endoscopically in 7.1% of subjects. Acute pancreatitis was the most communal complication occurred in 5.7% of cases. Bleeding occurs in 4.3% of cases; 4.3% have acute cholangitis and perforation in 2.9%. Conclusions: In spite of its complications and limitations, ERCP is a reliable stenting procedure as a palliative and tissue diagnostic tool for blockage due to malignant tumor and in the treatment of obstructive jaundice and most benign diseases. In this study, the effectiveness of ERCP in the treatment of obstructive jaundice is satisfactory. Keywords: Cholangiocarcinoma, pancreatic carcinoma, ERCP, Obstructive jaundice, and Stenting.

Endoscopic retrograde cholangiopancreatography in the treatment of obstructive jaundice in choledocholithiasis in pregnant women

The results of the use of direct choledochoscopy with the SpyGlass system in a pregnant woman at 30 weeks’ gestation are presented. This method has been found optimal during pregnancy since it provides direct visualization of bile ducts, and there are no adverse health effects to a mother or fetus from ionizing radiation exposure. Key words: gallstone disease, choledocholithiasis, endoscopic retrograde cholangiopancreatography, choledochoscopy, SpyGlass

Complications due to Biliary Stent Deviation

We often encounter complications from biliary stents used as a treatment for obstructive jaundice and acute cholangitis. Early complications after stent placement include pancreatitis, bleeding, and duodenal perforation [1]. Stent deviation is also a complication. This is particularly prominent for plastic stents, where stent deviation is observed in 6-18.7 % of cases [2]. Stent deviation is more common among patients who have undergone endoscopic sphincterotomy (Figure 1). Most deviated biliary plastic stents are excreted in stool or collected endoscopically, but, very rarely, complications causing gastrointestinal perforation have been reported. We have described deviated biliary plastic stents causing sigmoid colon diverticulum perforation and even uterine appendage penetration (Figure 2). Diagnosis can be made from clinical symptoms and abdominal computed tomography. Treatment is basically surgery. Biliary stent-related complications are inevitable, and sometimes become serious. On suspicion of such complications, the most important issue is to accurately and rapidly diagnose complications and conduct appropriate management.

[Expert consensus on enhanced recovery concept for the application of standardized management on obstructive jaundice].

Obstructive jaundice is characterized by complex management,more complications,slow recovery and long hospital stay due to special anatomy of the biliary tract system and the complicated pathophysiological changes.Enhanced recovery concept,which is the core of enhanced recovery after surgery,can be applied to the treatment of obstructive jaundice,which can alleviate stress responses,intervene early,reduce complications,shorten the length of hospital stay,reduce risk of readmission and average medical costs,its core concept consists in early removal of obstruction,recovering continuity of the biliary tract,normalizing the enterohepatic circulation of bile,accelerating the recovery the liver and other organs' function,and reducing postoperative complications.Based on this,Study Group of Biliary Tract Surgery in Chinese Society of Surgery of Chinese Medical Association,Hepatobiliary Committee of Bethune Charitable Foundation and Editorial Board of Chinese Journal of Surgery organized experts to make this consensus jointly. The consensus includes 17 recommendations about general contents,preoperative biliary drainage of obstructive jaundice and treatment of diseases related to obstructive jaundice.The consensus aims to provide a reference to the standardization and normalization of ERC in the treatment of obstructive jaundice in China.

Evaluation of the efficacy of Remaxol in the treatment of obstructive jaundice caused by a tumor process at different sites

Evaluation of the efficacy of Remaxol in the treatment of obstructive jaundice caused by a tumor process at different sites

Palliative Surgical Treatment for Liver Metastases Arising From Breast Cancer

Introduction Patients with liver metastases arising from breast cancer presenting with jaundice have poor prognoses; most patients are not treated aggressively. However, we report an improvement in the quality of life (QOL) of the patient by inserting a biliary stent as palliative surgical treatment. Case presentation The patient was a 63-year-old woman. She had left breast cancer and had undergone total mastectomy and axillar lymph node dissection approximately 20 years ago. Thereafter, chemotherapy and hormonal therapy were continued for approximately 5 years. Sixteen years after surgery, the patient presented with hepatic failure; furthermore, total bilirubin (T-Bil) levels had increased to 5.5 mg/dL. Imaging revealed multiple liver metastases and dilatation of the intrahepatic bile duct. A biliary stent was placed, and treatment for obstructive jaundice was administered. After 3 months, the patient was able to maintain QOL without any increase in T-Bil levels. Conclusion Palliative surgical treatment via biliary stenting for the onset of obstructive jaundice caused by liver metastases arising from breast cancer can be useful for maintaining patient QOL.

Application of ultrasound-guided percutaneous transhepatic bile duct drainage in 100 cases

Objective To investigate the clinical effect of percutaneous transhepatic bile duct drainage guided by ultrasound. Methods From June 2016 to June 2018, 100 patients with obstructive jaundice in Lishui Central Hospital were treated with ultrasound-guided percutaneous transhepatic bile duct drainage.The success rate and postoperative complications of the patients were analyzed. Results Among 100 cases, 98 cases were successful, 2 cases failed, and the failure rate was 2%.The success rate of one-time catheterization in 0.5-2.0 cm patients with intrahepatic bile duct diameter(98.91%) was significantly higher than that in intrahepatic bile duct diameter 0.3-0.4 cm patients(87.50%), compared with two different diameter puncture catheterization, the difference was statistically significant(χ2=12.369, P<0.05). All 98 cases with successful puncture were followed up after operation (P<0.05), and there was no statistically significant difference between the two groups(P<0.05). The drainage tube was removed in 2 cases, bile duct infection was found in 2 cases, the remaining patients were unobstructed, and there were no obvious complications. Conclusion Ultrasound-guided percutaneous transhepatic catheterization and drainage for the treatment of obstructive jaundice caused by malignant tumor is simple, reliable, safe and effective, and has a certain clinical value.It is worthy of popularizing and application. Key words: Drainage; Bile ducts; Punctures; Liver; Ultrasongraphy

Combined application of minimally invasive technologies in the treatment of obstructive jaundice

Successful combined minimally invasive intervention (antegrade and retrograde) in a patient with choledocholithiasis and previous pancreatoduodenectomy is described in the article.

Low-intensive Laser Therapy for Management of Cerebral Dysfunction in Patients with Obstructive Jaundice of Non-tumor Origin

 BACKGROUND The liver’s function is impaired above all others in the mechanical jaundice, which leads to the progression of endogenous intoxication and the damage of different organs and systems, including the brain. The development of hepatic encephalopathy undoubtedly aggravates the course of the disease, which requires its timely management.AIM OF STuDy: to evaluate the effcacy of the low-intensity laser therapy when managing the cerebral dysfunction in mechanical jaundice of non-tumor origin.MATERIAL AND METHODS A comprehensive study of 60 patients with obstructive jaundice of non-tumor origin was performed. The patients were divided into 2 groups: I (comparison) — the standard therapy (n=30); II (studied) group — inclusion of low-intensity laser irradiation of blood (n=30). On check dates (day 1 and 7), the severity of cerebral dysfunction was assessed in all patients using the psychometric tests (“Point in Circle, “Labyrinth”). The microcirculation was assessed with LACC 02 device (Russia). The coagulation/lysis system of blood was studied with TEG 5000 thrombelastograph (USA).RESULTS In patients with obstructive jaundice, disorders of the functional state of the liver were noted, which resulted in the growth of total bilirubin, alanine and aspartic aminotransferases, and toxic products. All this was accompanied by cerebral dysfunction, which was shown by results of the psychometric study and extended performance of tests, in particular (“Point in Circle”, “Labyrinth”). Signifcant changes and disorders of the hemostatic system were revealed in patients. The complex treatment of obstructive jaundice, which included laser therapy, allowed a relatively rapid recovery of the functional state of the brain to be observed, as evidenced by the shortening of the test time for the tests being studied. The positive effect of this kind of therapy was accompanied by a decrease in the severity of the syndrome of endogenous intoxication, improved microcirculation and hemostasis.CONCLUSION The presence of pancreatic obstructive jaundice lead to the development of florid syndrome of endogenous intoxication, which was reflected in the growth of ALT, AST, amylase, and total bilirubin. During the entire period of the study, a decrease in studied blood parameters was observed in patients who had underwent low-intensity laser therapy sessions. Conducting a psychometric study in the initial periods revealed some violations, such as extended performance of tests (“Point in Circle”, “Labyrinth”).

The effectiveness of the percutaneous trans hepatic cholangiostomy in the treatment of obstructive jaundice

The effectiveness of the percutaneous trans hepatic cholangiostomy in the treatment of obstructive jaundice

Percutaneous transhepatic cholangiobiopsy.

Most tumors of the biliary tract are too small to have specific imaging characteristics or for percutaneous puncture to provide sufficient material for diagnosis. Percutaneous transhepatic biliary drainage, in addition to being a well-established technique in the treatment of obstructive jaundice, provides adequate access for sampling obstructive lesions. In cases of biliary lesions, percutaneous transhepatic biopsy of the biliary tract has proven to be a useful diagnostic technique, with a reported accuracy of over 90% at some referral centers.

Safety and efficacy of irreversible electroporation in the treatment of obstructive jaundice in advanced hilar cholangiocarcinoma

BackgroundIrreversible electroporation (IRE) has successfully been used for palliation of pancreatic and liver cancers due to its ability to ablate tumors without destroying nearby vital structures. To date, it has not been evaluated in patients with advanced hilar cholangiocarcinoma (AHC). This study presents a single-institution experience with IRE for management of obstructive jaundice in AHC. MethodsA single-institution database was queried for patients undergoing IRE for AHC after PTBD placement for relief of obstructive jaundice from 2010 to 2017 and compared to a control group treated with standard of care only (No IRE). ResultsTwenty-six patients underwent IRE for AHC after PTBD replacement. Three patients experienced complications, with two experiencing severe (≥ grade 3) complications. After IRE, median time to PTBD removal was 122 days (range 0–305 days) and median catheter-free time before requiring PTBD replacement was 305 days (range 92–458 days). In comparison, the 137 control patients had an admission rate of 59% (N = 80 patients) for PTBD infection, occlusion, or catheter related problem. ConclusionIRE safely achieves biliary decompression via tumor electroporation and allows PTBD removal for an extended period of time. In appropriately selected patients with obstructive jaundice in the setting of AHC, IRE can be used to increase catheter-free days and optimize overall quality of life.

Safety and efficacy of irreversible electroporation in the treatment of obstructive jaundice in locally advanced hilar cholangiocarcinoma

Safety and efficacy of irreversible electroporation in the treatment of obstructive jaundice in locally advanced hilar cholangiocarcinoma

Surgical Bypass versus Endoscopic Stenting for Unresectable Head Pancreatic Cancer, Which Palliative Treatment Is Better in Developing Countries, Morocco as an Example

Background: Metal stents for unresectable pancreatic cancer are associated with longer patency and superior cost-effectiveness. However, they are too expensive to be recommended routinely in developing countries. Moreover, a debate on outcome results in these patients who receive plastic biliary endoprothesis versus surgical bypass as palliation of obstructive jaundice. We aimed to compare retrospectively the outcomes in patients treated with plastic stent or surgical bypass as a palliative option for these patients. Patients and Methods: We have examined data for patients (n = 86) who received endoscopic stenting (n = 64) or surgical bypass (n = 22), from January 2013 to November 2016, as a palliative treatment for obstructive jaundice from inoperable cancer head pancreas. Results: Serum bilirubin and CA19.9 levels were comparable in age and gender matched patient groups. Moreover, post-operative major complications and 30-days mortality showed no significant differences among patient groups. However, surgical bypass treated patients showed longer initial hospital stay (9 vs. 6 days, p = 0.014), higher cost ($1600 vs. $1088) and longer survival (192 vs. 101 days, p = 0.003) compared to endoscopy-stenting treated patients. Re-hospitalization was required for 5 stented patients (averaged $448). Conclusion: Biliary bypass surgery for unresectable pancreatic cancer may improve patient survival, although prolongs hospital stay. It may be recommended for relatively fit patients with a life expectancy of 6 months and more.

Ways to improve the results of surgical treatment for obstructive jaundice on the background of gall stone disease

The relevance of the problem of obstructive jaundice is caused primarily by an increase in the number of these patients, which reaches 22 % among persons with hepatopancreatoduodenal pathology. At the same time, nearly 50 % of patients seek surgical treatment late, which leads to severe morphological and biochemical changes in the liver, and hepatic progression to multiple organ failure. The analysis of the results of treatment in patients with obstructive jaundice on the background of cholelithiasis was performed. The study included 50 patients, who were treated surgically. They were divided into two equal groups, one of which in addition to standard treatment received L-lysine aescinat and glutargin. Research showed advantages of this treatment, an earlier elimination of symptoms in patients with hepatic impairment and, consequently, milder postoperative period.

Mo2080 EUS-Guided Intrahepatic Biliary Drainage for Treatment of Obstructive Jaundice in Patients With Malignant Hilar Biliary Stricture After Ineffective or Unsuccessful Transpapillary Approach

Mo2080 EUS-Guided Intrahepatic Biliary Drainage for Treatment of Obstructive Jaundice in Patients With Malignant Hilar Biliary Stricture After Ineffective or Unsuccessful Transpapillary Approach

Laparoscopic cholecystostomy in treatment of obstructive jaundice

Cholecystostomy is considered to be a treatment option when conservative treatment of acute cholecystitis failed in elderly and critically ill patients. The aim of this paper is to present a cholecystostomy in the treatment of obstructive jaundice before the definitive operation for the underlying cause of jaundice. The patient in poor general condition with the obstructive jaundice was diagnosed to have a pancreatic head tumor. He had undergone the laparoscopic cholecystostomy. After improvement of the general condition and lower total bilirubin level, the patient had undergone to definitive procedure. It is shown that laparoscopic cholecystostomy can be a successful way for adequate bile drainage in a patient with poor general condition before the definitive treatment of obstructive jaundice.

Clinical effects of endoscopic sphincterotomy and papillary balloon dilation for treatment of obstructive jaundice

Clinical effects of endoscopic sphincterotomy and papillary balloon dilation for treatment of obstructive jaundice

One‐step percutaneous transhepatic insertion of a balloon‐expanding metallic stent for obstructive jaundice

The aim of this study was to evaluate the efficacy and safety of one-step percutaneous transhepatic insertion of the Express LD stent, a balloon-expanding stainless steel stent used for the management of distal artery stenosis in the treatment of obstructive jaundice caused by various inoperable malignancies. Seventy-one consecutive patients with unresectable malignant biliary obstruction who underwent Express LD stent placement between 2007 and 2010 at our institute were reviewed. Mean stent patency was 165 ± 144 days and mean patient survival was 180 ± 156 days, while the cumulative stent patency rate and patient survival rate at 6 and 12 months were 79% and 65%, and 38% and 16%, respectively. Stents were successfully placed in all cases without any stent migration or misplacement. Stent failure occurred in 14 patients (20%), and 16 complications were observed, including 12 cholangitis (17%), two cholecysitis (3%), and two pancreatitis (3%). Y-configuration stenting for hilar bile duct obstruction was the only independent prognostic factor for stent failure. One-step percutaneous transhepatic insertion of the Express LD stent is effective and safe for the management of obstructive jaundice caused by inoperable malignancies.