Effectiveness of the endoscopic treatment for malignant extrahepatic biliary obstruction

Abstract

The causes of malignant extrahepatic biliary obstruction (MEBO) are pancreatic head carcinoma, ampulloma, cholangiocarcinoma, gall bladder cancer, less often — metastatic lymph nodes. Endoscopic biliary drainage (EBD) of extrahepatic ducts (ED) including stent placement plays a key role for cholestasis resolving. Aim — to evaluate the effectiveness of EBD in case of MEBO, depending on its level. Data of 36 patients with MEBO treated with EBD were retrospectively analyzed. Statistic methods: mean value and standart diviation were used. Ampulloma was the cause of MEBO in 7 cases, EBD was effective in all of them. Of 18 patients with MEBO at the level of distal 1/3 of ED, EBD was effective in 13. In the case of an MEBO of the middle 1/3of ED, EBD was successful in 3 of 6 patients, in the proximal 1/3 — in 3 out of 5. Thus, endoscopic biliary drainage was successful in 72% cases of malignant biliary obstruction. In case of obstruction at the papilla level, the success of endoscopic drainage has been achieved in all cases. Failure of EBD was due to inability of performing ERCP — mainly in cases of distal obstruction and the inability to get through obstruction — in the middle and proximal sections of the extrahepatic biliary tract.