Management of distal malignant biliary obstruction

Aljahdli, Emad

doi:10.4103/sjg.sjg_611_17

Cited by 6 publications

(4 citation statements)

References 13 publications

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“…The etiology is usually polymicrobial, with enteric gram-negative rods, Enterococcus spp., and anaerobes being most common [86]. Management of MBO includes percutaneous transhepatic biliary drainage [87] and endoscopic retrograde cholangiopancreatography (ERCP) with the placement of plastic or self-expandable metallic stents (SEMS), which is considered the current mainstay of treatment [84,88]. In patients with resectable disease, up-front surgery without a stent placement is an option and does not increase the risk of complications compared to preoperative biliary drainage [84].…”

Section: Tumor Obstructionmentioning

confidence: 99%

Risk Factors for Infections, Antibiotic Therapy, and Its Impact on Cancer Therapy Outcomes for Patients with Solid Tumors

Kubeček

Paterová

Novosadová

2021

Life

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Infections represent a significant cause of morbidity and mortality in cancer patients. Multiple factors related to the patient, tumor, and cancer therapy can affect the risk of infection in patients with solid tumors. A thorough understanding of such factors can aid in the identification of patients with substantial risk of infection, allowing medical practitioners to tailor therapy and apply prophylactic measures to avoid serious complications. The use of novel treatment modalities, including targeted therapy and immunotherapy, brings diagnostic and therapeutic challenges into the management of infections in cancer patients. A growing body of evidence suggests that antibiotic therapy can modulate both toxicity and antitumor response induced by chemotherapy, radiotherapy, and especially immunotherapy. This article provides a comprehensive review of potential risk factors for infections and therapeutic approaches for the most prevalent infections in patients with solid tumors, and discusses the potential effect of antibiotic therapy on toxicity and efficacy of cancer therapy.

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Section: Tumor Obstructionmentioning

confidence: 99%

Risk Factors for Infections, Antibiotic Therapy, and Its Impact on Cancer Therapy Outcomes for Patients with Solid Tumors

Kubeček

Paterová

Novosadová

2021

Life

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“…Distal malignant biliary strictures (DMBS) are most commonly caused by pancreatic adenocarcinoma. Less than 15% of DMBS are resectable at the time of diagnosis; therefore, endoscopic management is classically directed towards palliative therapies, including stenting for biliary drainage and endobiliary ablation [16].…”

Section: Unresectable Distal Malignant Biliary Stricturementioning

confidence: 99%

Endoscopic Management of Malignant Biliary Stricture

Dorrell

Pawa

2020

Diagnostics

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A biliary stricture is an area of narrowing in the extrahepatic or intrahepatic biliary system. The majority of biliary strictures are caused by malignancies, particularly cholangiocarcinoma and pancreatic adenocarcinoma. Most malignant biliary strictures are unresectable at diagnosis. Treatment of these diseases historically required surgical procedures, however, the development of endoscopic techniques has provided alternative minimally invasive treatment options to improve patient quality of life and survival with unresectable disease. While endoscopic retrograde cholangiopancreatography with stent placement has been the cornerstone of biliary drainage for decades, cutting edge endoscopic developments, including radiofrequency ablation and endoscopic ultrasound-guided biliary drainage, offer new therapy options to patients that historically have a poor quality of life and a grim prognosis. In this review, we explore the endoscopic techniques that have contributed to revolutionary advancements in the endoscopic management of malignant biliary strictures.

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“…About 15-24% of the patients who had surgical intervention for suspected IBDS have a benign etiology. 3,4 Conventional cytological evaluation (CCE) has become the standard modality of practice to evaluate such stricture. CCE had low diagnostic yield with an overall sensitivity of 41.6% and a negative predictive value of 58%.…”

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confidence: 99%

Digital Image Analysis has an Additive Beneficial Role to Conventional Cytology in Diagnosing the Nature of Biliary Ducts Stricture

Helmy

Eldien

Seifeldein

et al. 2021

Journal of Clinical and Experimental Hepatology

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Background & Aim: Conventional cytological evaluation (CCE) fails to identify nature indeterminate biliary duct stricture (IBDS) in many cases. Digital image analysis (DIA) has the ability to identify and analyze the DNA content of cells. This study assesses the role of DIA in recognizing the nature of IBDS compared to CCE. Methods: A prospective observational study was conducted at the Al-Rajhi University Hospital. Fifty patients with IBDS, based on abdominal imaging, were subjected to endoscopic retrograde cholangiopancreatography (ERCP) and brush sampling. These samples were evaluated with CCE and DIA. Follow-up for at least 9 months and costanalysis had also been done. Results: Based on the final diagnosis, 32 (64.0%) patients had malignant stricture, and 39 (78.0%) had distal stricture. DIA had 84.40% (95% CI; 67.20-94.70) sensitivity and 94.40% (95% CI; 72.70-99.90) specificity in identifying nature of IBDS, whereas CCE had 19.0% (95% CI; 7.20-36.40) sensitivity and 89.0% (95% CI; 65.30-98.60) specificity. Combination of both modalities had 84.40% (95% CI; 67.20-94.70) sensitivity and 83.30% (95% CI; 58.60-96.40) specificity in identification nature of IBDS. Based on CCE alone, only 6/32 ( 18.80%) of malignant stricture were diagnosed, and 26/32 (81.20%) were missed. However, DIA alone was able to diagnose 27/32 (84.40%) of malignant stricture, and only 5 cases were missed. Both procedures had detection rate of malignant stricture as DIA alone. Benign stricture was correctly diagnosed in 16/18 (88.80%), 17/ 18 (94.40%), and 15/18 (83.30%) using CCE alone, DIA alone, and both procedures together, respectively. Cost per detection additional one malignant stricture using DIA required 99.4$. Conclusion: DIA is substantially better than CCE in diagnosing the nature of IBDS but at an increase cost and thus suggests its application in a wider role in clinical practice. Clinical trial number: NCT04112030 (

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Management of distal malignant biliary obstruction

Cited by 6 publications

References 13 publications

Risk Factors for Infections, Antibiotic Therapy, and Its Impact on Cancer Therapy Outcomes for Patients with Solid Tumors

Risk Factors for Infections, Antibiotic Therapy, and Its Impact on Cancer Therapy Outcomes for Patients with Solid Tumors

Endoscopic Management of Malignant Biliary Stricture

Digital Image Analysis has an Additive Beneficial Role to Conventional Cytology in Diagnosing the Nature of Biliary Ducts Stricture

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