Endoscopic management of malignant biliary stenosis. Update and highlights for standard clinical practice

Mj, Domper Arnal; Ma, Simón

doi:10.17235/reed.2016.3912/2015

Cited by 3 publications

(5 citation statements)

References 37 publications

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“…Hence, the long-term benefit of using fully covered SEMS is applicable in only a small number of patients. Regardless, their use may be beneficial to patients that are candidates to neoadyuvant treatment and surgery with curative intentions, if we take into account that neoadjuvant therapy has a mean duration of 104 days (18); besides, they do not need to be withdrawn before surgery and in many patients this will be the final treatment modality.…”

Section: Discussionmentioning

confidence: 99%

Comparison of covered and uncovered self-expandable stents in the treatment of malignant biliary obstruction

Carmona¹,

Lárraga²,

Guerrero³

et al. 2016

Rev Esp Enferm Dig

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Background and objective: Drainage with metallic stents is the treatment of choice in malignant obstructive jaundice. Technical and clinical success with metallic stents is obtained in over 90% and 80% of cases, respectively. There are self-expandable metallic stents designed to increase permeability. The aim of this study was to describe the results obtained with totally covered self-expandable and uncovered self-expandable metallic stents in the palliative treatment of malignant biliary obstruction.Patients and methods: Sixty eight patients with malignant obstructive jaundice secondary to pancreatobiliary or metastatic disease not amenable to surgery were retrospectively included. Two groups were created: group A (covered self-expandable metallic stents) (n = 22) and group B (uncovered self-expandable metallic stents) (n = 46).Results: Serum total bilirubin, direct bilirubin, alkaline phosphatase and gamma glutamyl transferase levels decreased in both groups and no statistically significant difference was detected (p = 0.800, p = 0.190, p = 0.743, p = 0.521). Migration was greater with covered stents but it was not statistically significant either (p = 0.101). Obstruction was greater in the group with uncovered stents but it was not statistically significant either (p = 0.476).Conclusion: There are no differences when using covered self-expandable stents or uncovered self-expandable stents in terms of technical and clinical success or complications in the palliative treatment of malignant obstructive jaundice.

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Section: Discussionmentioning

confidence: 99%

Comparison of covered and uncovered self-expandable stents in the treatment of malignant biliary obstruction

Carmona¹,

Lárraga²,

Guerrero³

et al. 2016

Rev Esp Enferm Dig

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“…Основними причинами пухлинної обструкції позапечінкових жовчних шляхів (ПОПЖШ) є рак головки підшлункової залози, великого дуоденального сосочка (ВДС), холангіокарцинома загальної печінкової протоки і холедоха, рак жовчного міхура [1,3,4,6,7]. Більш рідкісна причина -метастатичне ураження лімфатичних вузлів воріт печінки і гепатодуоденальної зв'язки, джерелами якого є злоякісні пухлини іншої локалізації (шлунок, ободова кишка і т.…”

Section: вступunclassified

“…На момент первинного звернення близько 40-50% хворих з ПОПЖШ потребують тільки паліативного лікування, основна мета якого -відновлення відтоку жовчі [4,6,7]. З метою декомпресії жовчних проток при ПОПЖШ використовуються накладення обхідних біліодігестівних анастомозів, черезшкірне дренування жовчних шляхів й ендоскопічне дренування [1][2][3][4][5][6][7]. Через меншу інвазивність втручання ендоскопічному дренуванню віддається перевага [1,4].…”

Section: вступunclassified

“…З метою декомпресії жовчних проток при ПОПЖШ використовуються накладення обхідних біліодігестівних анастомозів, черезшкірне дренування жовчних шляхів й ендоскопічне дренування [1][2][3][4][5][6][7]. Через меншу інвазивність втручання ендоскопічному дренуванню віддається перевага [1,4]. З цією метою використовують назобіліарне дренування й установку пластикових або металевих стентів [1,3,4,5,7].…”

Section: вступunclassified

“…Через меншу інвазивність втручання ендоскопічному дренуванню віддається перевага [1,4]. З цією метою використовують назобіліарне дренування й установку пластикових або металевих стентів [1,3,4,5,7]. Проте, виконати ендоскопічне дренування жовчних проток за умови їхньої пухлинної обструкції вдається не завжди [3,7].…”

Section: вступunclassified

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Effectiveness of the endoscopic treatment for malignant extrahepatic biliary obstruction

Mamontov¹,

Тамм²,

Kramarenko³

et al. 2018

Rep. of Vinnytsia Nation. Med. Univ.

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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.

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Endoscopic retrograde cholangiopancreatography and endoscopic decompression in the malignant obstruction of the extrahepatic biliary tracts – a retrospective analysis

et al. 2023

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Background. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic biliary decompression are of the highest priority among minimally invasive procedures for the correction of the malignant obstruction of the extrahepatic biliary tracts. For this purpose, nasobiliary drainage and plastic or metal stents are used. However, it is not always possible to perform the endoscopic drainage of biliary ducts when there is a malignant obstruction. Purpose – to assess the immediate results of the use of the ERCP and endoscopic biliary decompression in malignant obstruction of the extrahepatic biliary tracts depending on the degree of obstruction. Materials and methods. A retrospective analysis of 106 cases of the malignant obstruction of the extrahepatic biliary tracts was performed. Out of 106 patients, 43 (40,6%) were males, and 63 (59,4%) were females. The age range of the patients was from 42 to 90 (68,4±11,1) years. Obstruction at the level of the major duodenal papilla was in 18 (17%) patients; at the level of the distal third of the common bile duct – in 66 (62,3%) patients; at the level of the middle third of the common bile duct – in 11 (10,4%) patients; at the level of the proximal third of the common bile duct – in 11 (10,4%) patients. Results. Out of 106 patients we managed to perform the ERCP in 94 (88,7%), and in 79 (84%) of them endoscopic drainage was successful. The complications after the ERCP were observed in 9 (8,5%) patients. In the malignant obstruction of the extrahepatic biliary tracts at the level of the major duodenal papilla we managed to perform the ERCP and restore the bile outflow in 17 out of 18 patients. In the malignant obstruction of the common bile duct, we managed to perform the ERCP in 77 (87,5%) out of 88 patients. In the obstruction at the level of the distal third, the endoscopic drainage was successful in 50 (87,7%) out of 57 patients who had undergone the ERCP. In the obstruction of the middle and proximal thirds of the common bile duct, the endoscopic drainage was successful in 12 (60%) out of 20 patients in which we managed to perform the ERCP. In the tumoral obstruction of the common bile duct, decompression at the level of the distal third was more successful (p = 0,027). Taking into consideration the obstruction of the major duodenal papilla, endoscopic biliary decompression was much more effective in the obstruction at the level of the major duodenal papilla and the distal third of the common bile duct compared to the obstruction of more proximal regions of the common bile duct (p = 0,002). In the tumoral obstruction of the extrahepatic biliary tracts at the level of the middle and proximal thirds of the common bile duct, the development of acute pancreatitis was characteristic of this process (p = 0,027). Conclusions. The performed retrospective analysis of the use of the ERCP in the malignant obstruction of the extrahepatic biliary tracts showed higher effectiveness of the endoscopic decompression in the obstruction of the distal regions of the extrahepatic biliary tracts compared with the obstruction at the level of the middle and proximal thirds of the common bile duct. Acute pancreatitis as a complication of the ERCP and endoscopic surgeries was significantly more often observed in the obstruction at the level of the middle and proximal thirds of the common bile duct.

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Endoscopic management of malignant biliary stenosis. Update and highlights for standard clinical practice

Cited by 3 publications

References 37 publications

Comparison of covered and uncovered self-expandable stents in the treatment of malignant biliary obstruction

Comparison of covered and uncovered self-expandable stents in the treatment of malignant biliary obstruction

Effectiveness of the endoscopic treatment for malignant extrahepatic biliary obstruction

Endoscopic retrograde cholangiopancreatography and endoscopic decompression in the malignant obstruction of the extrahepatic biliary tracts – a retrospective analysis

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