Malignant jaundice: Results of diagnostic and therapeutic endoscopy

Abstract

Direct cholangiography plays an important role in the diagnosis of malignant obstructive jaundice. Endoscopic retrograde cholangiopancreatography is gradually gaining ground over percutaneous transhepatic cholangiography. Endoscopy can determine the exact location and extent of the obstruction. Typical changes of the ducts are often helpful in interpreting the causes of obstructive jaundice. Representation of the bile and pancreatic duct systems is successful in 95% of cases in the hands of an expert. Acute pancreatitis is a complication occurring in about 1% of cases. Immediate drainage can usually prevent septic complications. Endoscopic drainage is a palliative measure for inoperable patients. Compared to biliodigestive anastomoses, catheters are subject to clogging in the less-risky, nonsurgical method. Blockage causes late cholangitis which can only be recognized and remedied by regular after-care of the patient. Endoscopic placement of the prosthesis has an 85% rate of success. The rate of complications related to the procedure is 2%. The mortality rate is 1%.

Imaging Techniques in the Evaluation of Adenocarcinoma of the Pancreas

“…Four basic radiographic appearances, suggestive of cancer, have been reported by Soehendra et al [76]: obstruction (present in 50%), stenosis (present in 35%), tapering (present in 8%), and cavitation (present in 7%). Since 75% of tumors were located in the head of the pancreas in their study, 80% of the patients also had changes detected in the common bile duct [76]. Niederau and Grendell [77] combined data from 16 studies and calculated a sensitivity of 92% and a specificity of 96% for diagnosing pancreatic cancer by ERCP.…”

Laparoscopic choledochojejunostomy and gastrojejunostomy in a porcine model

“…Notably, recent advances have been made in endoscopic stenting of malignant bile duct obstruction including placement of silastic stents or metallic wall stents [8,15]. The problem is that although there is a high initial success rate, up to 60% of the silastic stents can become occluded, requiring replacement or revision.…”

Surgical Treatment of Pancreatic Cancer

“…Apart from the surgical therapy of obstructive jaundice, stent inserts placed percutaneously or endoscopically may also be considered. Both these techniques show success rates of around 85% with mortality rates of 10-20% in experienced hands [65][66][67][68][69] (table 1). Disadvantages of the biliary tract stents placed endoscopically or percutaneously include more frequent treatment later on owing to stent occlusions with renewed obstructive jaundice or, quite often, cholangitis which exposes the already weakened patient to additional stress and reduction in the quality of life [65][66][67][68][69].…”