Management of Malignant Biliary Obstruction

Lorenz, Jonathan M.

doi:10.1055/s-0036-1592330

Cited by 51 publications

(47 citation statements)

References 63 publications

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“…Coagulopathy (INR > 1.5, platelets < 50,000) is a relative contraindication. The procedure should not be performed when active cholangitis is present due to the risk of infection seeding and abscess formation . Laser lithotripsy is also ineffective on biliary sludge or cast material.…”

Section: Indicationsmentioning

confidence: 99%

Percutaneous transhepatic laser lithotripsy for intrahepatic cholelithiasis: A technical report

et al. 2019

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Summary Advances in interventional radiology have seen the adaptation of urological endoscopic laser techniques to treat biliary tract calculi. Percutaneous transhepatic biliary laser lithotripsy provides an effective alternative procedure for the management of intrahepatic or conventionally refractory choledocholithiasis which would otherwise require invasive and high‐risk surgical intervention. Several small studies have validated the procedure for management in this subset of patients, with most achieving 100% calculi clearance with minimal complications. Most patients are suitable for percutaneous transhepatic biliary laser lithotripsy. Preprocedural imaging is useful for evaluating stone burden and planning percutaneous access. Holmium lasers are commonly used and act by vaporising water particles on and in the calculi, fragmenting the stone via thermal expansion. A series of catheters, wires, sheaths and dilators are used to allow introduction of the choledochoscope and laser so that calculi can be targeted. Percutaneous transhepatic biliary laser lithotripsy is often used in conjunction with balloon dredging and biliary stricture dilatation. Only experienced interventionalists should perform this procedure, and users should be aware of associated hazards. Repeat percutaneous transhepatic cholangiography is routinely performed to confirm eradication of stones. Treatment of biliary calculi and obstruction is important in preventing diseases such as cholangitis and cirrhosis. For patients unsuitable for conventional treatment, percutaneous transhepatic laser lithotripsy is a safe and effective alternative when performed by experienced interventional radiologists. Preprocedural planning is imperative to procedure success.

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Section: Indicationsmentioning

confidence: 99%

Percutaneous transhepatic laser lithotripsy for intrahepatic cholelithiasis: A technical report

et al. 2019

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“…External drains could then be capped and eventually removed to allow normal antegrade flow with a lower risk of cholangitis. In addition, durable metal biliary endoprotheses could also provide a solution to maintain patency in cases of unresectable disease …”

Section: Discussionmentioning

confidence: 99%

“…be unfeasible in patients with ascites and can put patients at risk of external catheter dislodgement as well as bleeding, particularly in patients with coagulopathies. [21][22][23][24] Those patients with prolonged external drainage are at risk for dehydration, malabsorption, and electrolyte disturbances due to loss of biliary contents. 21,22 Selection of appropriate patients would thus be necessary for SOP procedures to achieve maximal benefit.…”

mentioning

confidence: 99%

“…[21][22][23][24] Those patients with prolonged external drainage are at risk for dehydration, malabsorption, and electrolyte disturbances due to loss of biliary contents. 21,22 Selection of appropriate patients would thus be necessary for SOP procedures to achieve maximal benefit. In light of this, percutaneous placement of internal stents that traverse an obstructing lesion but not the ampulla may offer the most optimal solution to biliary drainage in allowing normal flow of bile and preserving sphincter integrity.…”

mentioning

confidence: 99%

“…In addition, durable metal biliary endoprotheses could also provide a solution to maintain patency in cases of unresectable disease. 21,25,26 For those patients who do qualify for resection, biliary obstruction also presents a challenge in the preoperative setting. Obstruction is common in this patient population and surgical resection in the setting of unrelieved obstruction has been associated with elevated rates of postoperative mortality (3%-18%) resulting from liver failure.…”

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confidence: 99%

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Postbiliary drainage rates of cholangitis are impacted by procedural technique for patients with supra‐ampullary cholangiocarcinoma: A SEER‐Medicare analysis

Kariya

Wach

Ruff

et al. 2019

Journal of Surgical Oncology

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Background The optimal approach to biliary drainage for patients with supra‐ampullary cholangiocarcinoma remains undetermined. Violation of sphincter of Oddi results in bacterial colonization of bile ducts and may increase postdrainage infectious complications. We sought to determine if rates of cholangitis are affected by the type of drainage procedure. Methods We examined the Surveillance, Epidemiology, and End Results‐Medicare linked database from 1991 to 2013 for cholangiocarcinoma. Biliary drainage procedures were categorized as sphincter of Oddi violating (SOV) or sphincter of Oddi preserving (SOP). Patients were stratified by resection. Results A total of 1914 patients were included in the final analysis. A total of 1264 patients did not undergo a postdrainage resection (SOP 83, SOV 1181) while 650 did undergo a postdrainage resection (SOP 26, SOV 624). For those patients not undergoing a postdrainage resection, the rate of cholangitis 90 days after an SOP procedure was 19% compared with 34% in the SOV cohort (P = 0.007). For those patients undergoing a postdrainage resection, the rate of cholangitis 90 days after an SOP procedure was less than 42.3% compared with 30% in the SOV cohort (P = 0.66). Conclusion For patients with supra‐ampullary cholangiocarcinoma that did not undergo resection, biliary drainage procedures that violated the sphincter of Oddi were associated with increased rates of cholangitis.

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Efficacy and safety of endoscopic ultrasonography (EUS) hepaticogastrostomy (HGS) versus choledochoduodenostomy (CDS) in ERCP‐failed malignant biliary obstruction: A systematic review and META‐analysis

Rizqiansyah,

Awatara,

Amar

et al. 2024

JGH Open

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Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard in managing malignant biliary obstruction. The success of ERCP has limitations, whereas surgical biliary bypass and percutaneous transhepatic approaches, as alternative modalities, come with significant costs, longer durations, and higher levels of mortality and morbidity. Endoscopic ultrasonography (EUS)‐guided biliary drainage with two approaches, hepaticogastrostomy (EUS‐HGS) and choledochoduodenostomy (EUS‐CDS), is a favored and evolving alternative modality. This study aims to compare the efficacy and safety of EUS‐HGS and EUS‐CDS. We conducted a systematic review and meta‐analysis by searching PubMed, ScienceDirect, Cochrane Library, and Scholar databases up to August 2023, based on the 2020 PRISMA guidelines. We identified randomized and nonrandomized studies comparing the efficacy and safety of EUS‐HGS and EUS‐CDS. Outcome measures included technical and clinical success, side effects, and mean procedure time. Nine nonrandomized studies and two randomized controlled trials involving 537 patients (225 EUS‐HGS, 312 EUS‐CDS) were analyzed. No difference was found in technical success (OR, 0.83; 95% CI, 0.41–1.68; I2 = 0%) and clinical success between the two procedures (OR, 0.96; 95% CI, 0.51–1.81; I2 = 9.94%). Side effects were significantly higher in EUS‐HGS (OR, 2.01, 95% CI, 1.14–3.59; I2 = 0%). No significant difference in mean procedure time was observed between the two procedures (0.13; 95% CI, −0.15–0.41; I2 = 34.89%). There are differences in efficacy and safety between EUS‐HGS and EUS‐CDS. EUS‐CDS has a faster procedure time, lower risk of side effects, and ease of puncture during the procedure.

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Management of Malignant Biliary Obstruction

Cited by 51 publications

References 63 publications

Percutaneous transhepatic laser lithotripsy for intrahepatic cholelithiasis: A technical report

Percutaneous transhepatic laser lithotripsy for intrahepatic cholelithiasis: A technical report

Postbiliary drainage rates of cholangitis are impacted by procedural technique for patients with supra‐ampullary cholangiocarcinoma: A SEER‐Medicare analysis

Efficacy and safety of endoscopic ultrasonography (EUS) hepaticogastrostomy (HGS) versus choledochoduodenostomy (CDS) in ERCP‐failed malignant biliary obstruction: A systematic review and META‐analysis

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