High bile duct cancer: Incidence and pattern of investigation in the general hospital setting

Peel, A. L. G.; Dillon, E.; Dellipiani, A. W.

doi:10.1002/bjs.1800680706

Cited by 6 publications

(3 citation statements)

References 23 publications

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“…In the majority of patients with bile duct carcinoma obstructing the bile duct, however, ERCP does not provide sufficient information as to the anatomy of and the extent of the lesion to the proximal bile duct, which are essential for appropriate surgical treatment. Therefore, PTC is the preferred method of cholangiography in such patients [4][5][6][7].…”

Section: Discussionmentioning

confidence: 99%

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The role of endoscopic retrograde cholangiopancreatography in preoperative assessment of bile duct cancer

et al. 1988

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A total of 73 patients with carcinoma of the bile duct (59 patients) or duodenal papilla (14 patients) were reviewed with regard to the role of endoscopic retrograde cholangiopancreatography (ERCP) in preoperative assessment of these diseases. Percutaneous transhepatic cholangiography was preferred in most of the jaundiced patients and ERCP was performed after establishment of percutaneous or operative drainage above the obstruction. Pancreatography obtained in 19 patients with bile duct carcinoma revealed pancreatic invasion in 2 patients, and chronic pancreatitis in 1 patient. Other patients with normal pancreatograms included 2 patients whose initial diagnosis had been pancreatic cancer. The extent of bile duct carcinoma could be determined in 92% of 26 patients who had retrograde cholangiography, whereas it was known preoperatively in only 27% of 33 patients in whom retrograde cholangiography was not obtained. Combined use of antegrade and retrograde cholangiography performed in 13 patients was particularly useful to clearly delineate the lesion. In most of the patients with ampullary carcinoma, biopsy during ERCP confirmed the diagnosis preoperatively; 3 of these patients underwent ERCP with a different diagnosis. Biopsy after sphincterotomy revealed bile duct carcinoma in 2 patients in whom bile duct cancer was not suspected. Complications included 2 cases of cholangitis and 2 cases of mild pancreatitis. ERCP does not provide sufficient information as to the proximal bile duct anatomy and extent of the lesion, which are essential for appropriate surgical treatment. If used with precautions to prevent possible septic complications, however, it is useful in excluding pancreatic diseases by pancreatography, in specifying the distal bile duct, and in observing the duodenum and papilla. The use of several ERCP‐derived techniques such as perendoscopic biopsy, sphincterotomy, and balloon catheter cholangiography substantially increases the diagnostic utility of this procedure.

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Section: Discussionmentioning

confidence: 99%

“…a totally obstructing lesion [2,3]. Other investigators consider PTC the best diagnostic method since the procedure is far more successful in clarifying the anatomy of the dilated bile ducts above the obstruction and the proximal extent of the lesion, which are of primary importance from a surgical point of view [4][5][6][7].…”

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confidence: 99%

The role of endoscopic retrograde cholangiopancreatography in preoperative assessment of bile duct cancer

et al. 1988

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“…Visualization of the biliary tree is the pivotal step in the initial evaluation of obstructive jaundice and possible cholangiocarcinoma. Percutaneous transhepatic cholangiography (PTCA), has a success rate approaching 100% with bile duct dilatation, can assess the location and extent of biliary tract involvement, and has been proposed as a basis for determining surgical resectability (5)(6)(7)(8)(9).…”

mentioning

confidence: 99%

Cholangiocarcinoma

1988

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Exploratory laparotomy is frequently used to diagnose, treat, or palliate cholangiocarcinoma although surgery is rarely curative. In light of newly developed percutaneous and endoscopic approaches to diagnosis and therapy, we reviewed our experience with 35 cases of cholangiocarcinoma diagnosed and treated at the University of Michigan Medical Center from 1979 to 1984. Percutaneous transhepatic cholangiography (PTCA) was performed in 34 cases of which only four were resectable. All 22 patients who had preoperative cholangiograms suggesting unresectability had confirmation of this at surgery. Surgical palliation was accomplished with a combination of internal and percutaneous drainage in most cases. Angiographic, cytologic, and laboratory data are presented. PTCA accurately predicted unresectability of cholangiocarcinoma and is superior to angiography in this respect. In patients with cholangiocarcinoma, percutaneous and endoscopic approaches offer alternatives to surgery for diagnosis and palliation.

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Failure to improve survival by improved diagnostic techniques in patients with malignant jaundice

Gillen

Peel

1986

Journal of British Surgery

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In a consecutive series of 118 patients with malignant obstructive jaundice at North Tees General Hospital only 70 patients were adjudged fit to undergo surgery. Tumour resection was possible in only four patients. Palliative bypass was performed in 45 patients while 21 patients had no procedure other than an exploratory laparotomy. In contrast to the accuracy of investigation the results of surgery have been poor with considerable mortality (42.8 per cent) and lack of long-term survivors. The results emphasize the role of non-surgical methods for relieving jaundice of malignant aetiology, especially in frail elderly patients and those who have metastases at the time of presentation.

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High bile duct cancer: Incidence and pattern of investigation in the general hospital setting

Cited by 6 publications

References 23 publications

The role of endoscopic retrograde cholangiopancreatography in preoperative assessment of bile duct cancer

The role of endoscopic retrograde cholangiopancreatography in preoperative assessment of bile duct cancer

Cholangiocarcinoma

Failure to improve survival by improved diagnostic techniques in patients with malignant jaundice

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