Hepato-biliary-enteric stent drainage as palliative treatment for proximal malignant obstructive jaundice

Abstract

The proximal malignant obstructive jaundice remains one of the most challenging problems for hepato-biliary surgeons. Particularly when the findings preclude surgical resection at exploration, the next decision seems hard to make. A novel palliative treatment called "hepato-biliary-enteric stent drainage" was designed for these proximal malignant obstructive jaundice patients. Hepato-biliary-enteric stent drainage was performed with silicone tube whose diameter was determined according to the degree of dilated biliary ducts, and the proximal end of the tube was placed to intrahepatic ducts as far as possible, the distal end was placed across the duodenal papilla. Between February 2011 and August 2012, 23 patients with the proximal malignant obstructive jaundice of unresectable tumors at exploration received hepato-biliary-enteric stent drainage. Patient's liver function results, symptoms, complications, and survival time were documented. The bilirubin levels of all 23 patients had a considerable and persistent decrease after operation and remained low or normal before death except for four cases of recurrent jaundice (two resulted from migration of tube and other two resulted from hepatocellular carcinoma extensively involving liver parenchyma). After effective drainage, clinical symptoms of cholangitis such as fever or pain were markedly relieved. No procedure-related bleeding, bile leakage, pancreatitis were observed. The median survival time was 212 days, half-year and 1-year survival rate were 56.5 and 21.7%, respectively. Hepato-biliary-enteric stent drainage with less expense, less complications, and easy operation may be an ideal option for patients with unresectable malignancy in the hilar region at exploration.

Prognostic value of inflammation-based markers in patients with recurrent malignant obstructive jaundice treated by reimplantation of biliary metal stents

“…Our results regarding postoperative survival time were very promising and were consistent with the 6- to 9-month median survival time reported in previous studies. [ 18 – 20 ] Therefore, we conclude that biliary stent reimplantation improves the quality of life and increases survival time in patients with recurrent MOJ. Moreover, PTCD does not require complex equipment and patients are free from the high risk of surgery and general anesthesia.…”

Malignus gastroduodenalis obstrukció endoszkópos palliációja fedetlen enteralis stenttel

“…A stentek behelyezése terápiás gasztroszkóp munkacsatornáján keresztül vezetődrót segítségével történik endoszkópos kontroll és kiegészítő röntgenátvilágító kontroll alatt. Azokban a betegekben, ahol a malignus duodenalis obstrukciót pancreatobiliaris tumor okozza, szükségesnek tartjuk a preventív choledochusstentelést még abban az esetben is, ha jelentős szűkületre a képalkotó vizsgálatok, a laborvizsgálatok és az ERCP aktuálisan még nem utalnak [12]. Vélemé-nyünk szerint az epeutak utólagos stentelése endoszkó-pos úton az enteralis stenten keresztül technikailag nehezen kivitelezhető, nem biztonságos.…”

The role of growth factors on hepatic damage in rats with obstructive jaundice

“…Endoscopic biliary drainage is more effective than percutaneous external drainage because of high rate of complications. Bleeding, hemobilia, bile leakage, biliary fistula and peritonitis may be listed among the complications of percutaneous biliary drainage (Pan et al 2014 ).…”