Biliary Obstruction: Endoscopic Approaches

Lee, Jeffrey H.; DaVee, Tomas

doi:10.1055/s-0037-1608828

Cited by 7 publications

(1 citation statement)

References 28 publications

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“…This is becoming an attractive option for patients who cannot undergo conventional ERCP and who are not candidates for or refuse to undergo percutaneous or surgical drainage. The approach includes 3 techniques[55]:…”

Section: Palliative Biliary Drainagementioning

confidence: 99%

Diagnostic-therapeutic management of bile duct cancer

Huguet¹,

Lobo²,

Labrador³

et al. 2019

WJCC

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Biliary tract cancer, or cholangiocarcinoma, comprises a heterogeneous group of malignant tumors that can emerge at any part of the biliary tree. This group is the second most common type of primary liver cancer. Diagnosis is usually based on symptoms, which may be heterogeneous, and nonspecific biomarkers in serum and biopsy specimens, as well as on imaging techniques. Endoscopy-based diagnosis is essential, since it enables biopsy specimens to be taken. In addition, it can help with locoregional staging of distal tumors. Endoscopic retrograde cholangiopancreatography is a key technique for the evaluation and treatment of malignant biliary tumors. Correct staging of cholangiocarcinoma is essential in order to be able to determine the degree of resectability and assess the results of treatment. The tumor is staged based on the TNM classification of the American Joint Committee on Cancer. The approach will depend on the classification of the tumor. Thus, some patients with early-stage disease could benefit from surgery; complete surgical resection is the cornerstone of cure. However, only a minority of patients are diagnosed in the early stages and are suitable candidates for resection. In the subset of patients diagnosed with locally advanced or metastatic disease, chemotherapy has been used to improve outcome and to delay tumor progression. The approach to biliary tract tumors should be multidisciplinary, involving experienced endoscopists, oncologists, radiologists, and surgeons.

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Section: Palliative Biliary Drainagementioning

confidence: 99%

Diagnostic-therapeutic management of bile duct cancer

Huguet¹,

Lobo²,

Labrador³

et al. 2019

WJCC

View full text Add to dashboard Cite

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The performance of ultrasound in determining the cause of biliary dilation

Jones

Nečas

2018

Sonography

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Introduction Transabdominal ultrasound (US) is the modality of choice for the initial investigation of patients with suspected biliary disease. There are multiple factors that can affect the quality of an US examination including – operator experience, patient habitus and bowel gas. This study investigated the performance of US in determining the cause of biliary dilation and correlated US findings with definitive diagnoses from other modalities and procedures. Methods One hundred patients were retrospectively identified with an US‐reported common bile duct diameter of 8 mm or greater. Patient records were used to correlate US findings with ‘gold standard’ diagnostic tests – other imaging modalities with conclusive findings and/or endoscopic procedures or surgery with histology. The performance of US was calculated for the most common pathologies encountered. Results A definitive cause for dilation was identified in 38 patients (n = 38). The US diagnosis was correct in 19 of these patients (50% of cases where a cause was identified). Choledocholithiasis was the most common pathology, with 23 instances identified by US (61% of the cases where an aetiology was found). Malignancy formed the next largest group (four cases). Conclusions For most patients with a US‐reported common bile duct 8 mm or greater, a cause for biliary dilation was not established. Further study and methodological refinements are required to understand the clinical context of the cases with no recorded follow up. Performance of US is concordant with published literature. Distal choledocholithiasis remains a challenging area for US.

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