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1
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Kudaravalli P, Singh S, Facciorusso A. Lumen-Apposing Metal Stents for Palliation of Gastrointestinal Tumors. Cancers (Basel) 2025; 17:600. [PMID: 40002195 PMCID: PMC11853269 DOI: 10.3390/cancers17040600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2025] [Accepted: 02/08/2025] [Indexed: 02/27/2025] Open
Abstract
Interventional endoscopy is gaining ground in the armamentarium of the management of cancer-related complications [...].
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Affiliation(s)
- Pujitha Kudaravalli
- Gastroenterology & Hepatology, Lahey Hospital & Medical Center, Burlington, MA 01803, USA;
| | - Sahib Singh
- Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA;
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Experimental Medicine, Università del Salento, 73100 Lecce, Italy
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2
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Singh S, Dwivedi M, Pawar A, Kori M, Yadav A, Porwal P. Therapeutic prospects and challenges in the human genetic disorder hyperbiliverdinemia. HUMAN GENE 2024; 42:201342. [DOI: 10.1016/j.humgen.2024.201342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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3
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AbiMansour JP, Martin JA. Biliary Endoscopic Retrograde Cholangiopancreatography. Gastroenterol Clin North Am 2024; 53:627-642. [PMID: 39489579 DOI: 10.1016/j.gtc.2024.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2024]
Abstract
Since inception in 1968, biliary endoscopic retrograde cholangiopancreatography (ERCP) has transformed into a highly effective, minimally invasive modality for the identification and treatment of a variety of biliary pathologies including benign, malignant, and iatrogenic diseases. The diagnostic role of ERCP has been largely replaced by high-quality imaging modalities including endoscopic ultrasound and magnetic resonance cholangiopancreatography. However, there continues to be significant demand for therapeutic procedures. This article reviews the general principles of ERCP, as well as common indications, contraindications, and potential adverse events with which endoscopists and referring physicians should be familiar.
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Affiliation(s)
- Jad P AbiMansour
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - John A Martin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
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4
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Alipour S, Harzandi N, Sadeghi A, Rabbani A, Houri H. A worrisome prevalence of extended-spectrum β-lactamase producers in patients with biliary obstruction and cholangitis: Phenotypic and molecular characterization of biliary Escherichia coli and Klebsiella pneumoniae isolates. Microb Pathog 2024; 197:107026. [PMID: 39423918 DOI: 10.1016/j.micpath.2024.107026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 10/07/2024] [Accepted: 10/16/2024] [Indexed: 10/21/2024]
Abstract
BACKGROUND & AIMS The alarming rise of antibiotic resistance presents a substantial and worrisome issue within the context of biliary obstruction, specifically in the treatment of cholangitis. This abovementioned scenario underscores the critical importance of addressing extended spectrum β-lactamase (ESBL) producers in the biliary system to adequately tackle cholangitis using third-generation cephalosporins. Hence, we aimed to determine the frequency of ESBL and carbapenemases among biliary Escherichia coli and Klebsiella pneumoniae isolated from patients with biliary obstruction. METHODS In this cross-sectional study, bile samples were collected via aspiration from patients diagnosed with biliary obstruction during the endoscopic retrograde cholangiopancreatography (ERCP) procedure. Subsequent culturing of these samples was performed, followed by phenotypic and molecular assessments for the detection of ESBL- and carbapenemase-producing strains of E. coli and K. pneumoniae. RESULTS Approximately 23.5 % of patients with biliary obstruction harbored biliary ESBL-producers, with the majority (70.2 %) being diagnosed with cholangitis. Moreover, 2.1 % of patients had biliary carbapenemase-producing K. pneumoniae strains. Molecular analysis confirmed the high prevalence of blaCTX-M and blaTEM in E. coli, and blaTEM and blaSHV in K. pneumoniae. Additionally, the presence of biliary K. pneumoniae harboring blaKPC, blaNDM, and blaIMP was observed. CONCLUSION Our study reveals a noteworthy observation that over half of patients experiencing biliary obstruction harbor ESBL-producing bacteria in their biliary tract. Notably, we discovered a significant link between ESBL producers and the risk of cholangitis. These findings raise important concerns regarding the suitability of employing third-generation cephalosporins as initial treatment for cholangitis and other similar biliary infections.
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Affiliation(s)
- Samira Alipour
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Naser Harzandi
- Department of Microbiology, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Amir Sadeghi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhassan Rabbani
- Department of Transplant & Hepatobiliary Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Houri
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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5
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Rizqiansyah CY, Awatara PID, Amar N, Lesmana CRA, Mustika S. Efficacy and safety of endoscopic ultrasonography (EUS) hepaticogastrostomy (HGS) versus choledochoduodenostomy (CDS) in ERCP-failed malignant biliary obstruction: A systematic review and META-analysis. JGH Open 2024; 8:e70037. [PMID: 39439478 PMCID: PMC11494398 DOI: 10.1002/jgh3.70037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 09/19/2024] [Accepted: 09/23/2024] [Indexed: 10/25/2024]
Abstract
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; I 2 = 0%) and clinical success between the two procedures (OR, 0.96; 95% CI, 0.51-1.81; I 2 = 9.94%). Side effects were significantly higher in EUS-HGS (OR, 2.01, 95% CI, 1.14-3.59; I 2 = 0%). No significant difference in mean procedure time was observed between the two procedures (0.13; 95% CI, -0.15-0.41; I 2 = 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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Affiliation(s)
- Chrisandi Y Rizqiansyah
- Internal Medicine DepartmentFaculty of Medicine Universitas Brawijaya, Saiful Anwar General HospitalMalangIndonesia
| | | | - Nasim Amar
- Faculty of Medicine Universitas BrawijayaMalangIndonesia
| | - Cosmas R A Lesmana
- Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of MedicineUniversitas IndonesiaJakartaIndonesia
| | - Syifa Mustika
- Internal Medicine DepartmentFaculty of Medicine Universitas Brawijaya, Saiful Anwar General HospitalMalangIndonesia
- Gastroenterohepatology Division, Internal Medicine DepartmentFaculty of Medicine Universitas Brawijaya, Saiful Anwar General HospitalMalangIndonesia
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6
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Thalji SZ, Fernando D, Dua KS, Madhavan S, Chisholm P, Smith ZL, Aldakkak M, Christians KK, Clarke CN, George B, Kamgar M, Erickson BA, Hall WA, Evans DB, Tsai S. Biliary Adverse Events During Neoadjuvant Therapy for Pancreatic Cancer. Ann Surg 2023; 278:e1224-e1231. [PMID: 37078282 DOI: 10.1097/sla.0000000000005884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To describe a high-volume experience with biliary drainage before neoadjuvant therapy (NAT) for patients with operable pancreatic cancer (PC) and characterize the association between biliary adverse events (BAEs) and patient outcome. BACKGROUND Patients with PC presenting with biliary obstruction require durable decompression before NAT. METHODS Patients with operable PC and tumor-associated biliary obstruction were examined and grouped by the presence or absence of a BAE during NAT. The incidence, timing, and management of BAEs are described, and outcomes, including the completion of all treatment and overall survival (OS), were compared. RESULTS Of 426 patients who received pretreatment biliary decompression, 92 (22%) experienced at least 1 BAE during NAT, and 56 (13%) required repeat intervention on their biliary stent. The median duration of NAT was 161 days for all patients and was not different in the group that experienced BAEs. The median time from initial stent placement to BAE was 64 days. An interruption in the delivery of NAT (median 7 days) occurred in 25 (6%) of 426 patients. Among 426 patients, 290 (68%) completed all NAT, including surgery: 60 (65%) of 92 patients with BAE and 230 (69%) of 334 patients without BAE ( P =0.51). Among 290 patients who completed NAT and surgery, the median OS was 39 months, 26 months for the 60 patients with BAE, and 43 months for the 230 patients without BAE ( P =0.02). CONCLUSIONS During extended multimodal NAT for PC, 22% of patients experienced a BAE. Although BAEs were not associated with a significant interruption of treatment, patients who experienced a BAE had worse OS.
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Affiliation(s)
- Sam Z Thalji
- Division of Surgical Oncology, Department of Surgery, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI
| | - Deemantha Fernando
- Division of Surgical Oncology, Department of Surgery, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI
| | - Kulwinder S Dua
- Division of Gastroenterology, Department of Medicine, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI
| | - Srivats Madhavan
- Division of Gastroenterology, Department of Medicine, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI
| | - Phillip Chisholm
- Division of Gastroenterology, Department of Medicine, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI
| | - Zachary L Smith
- Division of Gastroenterology, Department of Medicine, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI
| | - Mohammed Aldakkak
- Division of Surgical Oncology, Department of Surgery, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI
| | - Kathleen K Christians
- Division of Surgical Oncology, Department of Surgery, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI
| | - Callisia N Clarke
- Division of Surgical Oncology, Department of Surgery, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI
| | - Ben George
- Division of Medical Oncology, Department of Medicine, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI
| | - Mandana Kamgar
- Division of Medical Oncology, Department of Medicine, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI
| | - Beth A Erickson
- Department of Radiation Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI
| | - William A Hall
- Department of Radiation Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI
| | - Douglas B Evans
- Division of Surgical Oncology, Department of Surgery, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI
| | - Susan Tsai
- Division of Surgical Oncology, Department of Surgery, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI
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Yu HJ, Park JG, Jung GS, Seo KI, Park HJ, Yun JH. Predictive Factors for Symptomatic Dislodgement of Percutaneous Transhepatic Biliary Drainage Catheter in Patients with Malignant Biliary Obstruction. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:1350-1360. [PMID: 38107686 PMCID: PMC10721429 DOI: 10.3348/jksr.2023.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/27/2023] [Accepted: 07/08/2023] [Indexed: 12/19/2023]
Abstract
Purpose To evaluate the factors that predict symptomatic dislodgement of a percutaneous transhepatic biliary drainage (PTBD) catheter in patients with malignant biliary obstruction. Materials and Methods This retrospective study included 572 patients with malignant biliary obstruction who underwent 733 PTBD catheter insertions between January 2010 and February 2015. The duration of catheter placement, approach site, location of the catheter tip, insertion angle, presence of a closed-loop pigtail, and tube diameter were evaluated. Results During the follow-up period, 224 PTBD catheter dislodgements (30.56%) were observed in 157 patients. Among them, 146 (19.92%) were symptomatic. The mean duration from catheter insertion until dislodgement was 32 days (range: 1-233 days). Male (odds ratio [OR]: 1.636, 95% confidence interval [CI]: 1.131-2.367, p = 0.009), right-sided approach (OR: 1.567, 95% CI: 1.080-2.274, p = 0.018), increased insertion angle (OR: 1.015, 95% CI: 1.005-1.026, p = 0.005), and incomplete closed-loop pigtail formation (OR: 1.672, 95% CI: 1.098-2.545, p = 0.016) were independent factors predictive of symptomatic dislodgement of a PTBD catheter. Conclusion Factors predictive of symptomatic catheter dislodgement included male sex, a right-sided approach, increased insertion angle, and incomplete closed-loop pigtail formation.
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Tsou YK, Su YT, Lin CH, Liu NJ. Acute cholangitis: Does malignant biliary obstruction vs choledocholithiasis etiology change the clinical presentation and outcomes? World J Clin Cases 2023; 11:6984-6994. [PMID: 37946763 PMCID: PMC10631399 DOI: 10.12998/wjcc.v11.i29.6984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/02/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Whether clinical outcomes of acute cholangitis (AC) vary by etiology is unclear. AIM To compare outcomes in AC caused by malignant biliary obstruction (MBO) and common bile duct stones (CBDS). METHODS This retrospective study included 516 patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) due to AC caused by MBO (MBO group, n = 56) and CBDS (CBDS group, n = 460). Clinical and laboratory parameters were compared between the groups. Propensity score matching (PSM) created 55 matched pairs. Confounders used in the PSM analysis were age, sex, time to ERCP, and technical success of ERCP. The primary outcome comparison was 30-d mortality. The secondary outcome comparisons were intensive care unit (ICU) admission rate, length of hospital stay (LOHS), and 30-d readmission rate. RESULTS Compared with the CBDS group, the MBO group had significantly lower body temperature, percentage of abnormal white blood cell counts, and serum levels of aspartate aminotransferase, alanine aminotransferase, and creatinine. Body temperature, percent abnormal white blood cell count, and serum aspartate aminotransferase levels remained significantly lower in the MBO group in the PSM analysis. Platelet count, prothrombin time/international normalized ratio, and serum levels of alkaline phosphatase and total bilirubin were significantly higher in the MBO group. The MBO group had a significantly higher percentage of severe AC (33.9% vs 22.0%, P = 0.045) and received ERCP later (median, 92.5 h vs 47.4 h, P < 0.001). However, the two differences were not found in the PSM analysis. The 30-d mortality (5.4% vs 0.7%, P = 0.019), ICU admission rates (12.5% vs 4.8%, P = 0.028), 30-d readmission rates (23.2% vs 8.0%, P < 0.001), and LOHS (median, 16.5 d vs 7.0 d, P < 0.001) were significantly higher or longer in the MBO group. However, only LOHS remained significant in the PSM analysis. Multivariate analysis revealed that time to ERCP and multiple organ dysfunction were independent factors associated with 30-d mortality. CONCLUSION MBO patients underwent ERCP later and thus had a worse prognosis than CBDS patients. Therefore, clinicians should remain vigilant in MBO patients with clinically suspected AC, and perform ERCP for biliary drainage as soon as possible.
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Affiliation(s)
- Yung-Kuan Tsou
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Yi-Tse Su
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Cheng-Hui Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Nai-Jen Liu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
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Najjar R. Redefining Radiology: A Review of Artificial Intelligence Integration in Medical Imaging. Diagnostics (Basel) 2023; 13:2760. [PMID: 37685300 PMCID: PMC10487271 DOI: 10.3390/diagnostics13172760] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 09/10/2023] Open
Abstract
This comprehensive review unfolds a detailed narrative of Artificial Intelligence (AI) making its foray into radiology, a move that is catalysing transformational shifts in the healthcare landscape. It traces the evolution of radiology, from the initial discovery of X-rays to the application of machine learning and deep learning in modern medical image analysis. The primary focus of this review is to shed light on AI applications in radiology, elucidating their seminal roles in image segmentation, computer-aided diagnosis, predictive analytics, and workflow optimisation. A spotlight is cast on the profound impact of AI on diagnostic processes, personalised medicine, and clinical workflows, with empirical evidence derived from a series of case studies across multiple medical disciplines. However, the integration of AI in radiology is not devoid of challenges. The review ventures into the labyrinth of obstacles that are inherent to AI-driven radiology-data quality, the 'black box' enigma, infrastructural and technical complexities, as well as ethical implications. Peering into the future, the review contends that the road ahead for AI in radiology is paved with promising opportunities. It advocates for continuous research, embracing avant-garde imaging technologies, and fostering robust collaborations between radiologists and AI developers. The conclusion underlines the role of AI as a catalyst for change in radiology, a stance that is firmly rooted in sustained innovation, dynamic partnerships, and a steadfast commitment to ethical responsibility.
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Affiliation(s)
- Reabal Najjar
- Canberra Health Services, Australian Capital Territory 2605, Australia
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McDonagh P, Awadelkarim B, Leeds JS, Nayar MK, Oppong KW. Endoscopic Ultrasound-Guided Gallbladder Drainage for Malignant Biliary Obstruction: A Systematic Review. Cancers (Basel) 2023; 15:2988. [PMID: 37296955 PMCID: PMC10251815 DOI: 10.3390/cancers15112988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/27/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is a rescue technique for patients with malignant biliary obstruction who fail conventional treatment with ERCP or EUS-guided biliary drainage. The technique has been successfully employed in the management of acute cholecystitis in patients not fit for surgery. However, the evidence for its use in malignant obstruction is less robust. This review article aims to evaluate the data available at present to better understand the safety and efficacy of EUS-guided gallbladder drainage. METHODS A detailed literature review was conducted and several databases were searched for any studies relating to EUS-GBD in malignant biliary obstruction. Pooled rates with 95% confidence intervals were calculated for clinical success and adverse events. RESULTS Our search identified 298 studies related to EUS-GBD. The final analysis included 7 studies with 136 patients. The pooled rate of clinical success (95% CI) was 85% (78-90%, I2: 0%). The pooled rate of adverse events (95% CI) was 13% (7-19%, I2: 0%). Adverse events included: peritonitis, bleeding, bile leakage, stent migration, and stent occlusion. No deaths directly related to the procedure were reported; however, in some of the studies, deaths occurred due to disease progression. CONCLUSION This review supports the use of EUS-guided gallbladder drainage as a rescue option for patients who have failed conventional measures.
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Affiliation(s)
- Padraic McDonagh
- HPB Medicine, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne NE7 7DN, UK; (P.M.); (B.A.); (J.S.L.); (M.K.N.)
| | - Bidour Awadelkarim
- HPB Medicine, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne NE7 7DN, UK; (P.M.); (B.A.); (J.S.L.); (M.K.N.)
| | - John S. Leeds
- HPB Medicine, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne NE7 7DN, UK; (P.M.); (B.A.); (J.S.L.); (M.K.N.)
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK
| | - Manu K. Nayar
- HPB Medicine, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne NE7 7DN, UK; (P.M.); (B.A.); (J.S.L.); (M.K.N.)
| | - Kofi W. Oppong
- HPB Medicine, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne NE7 7DN, UK; (P.M.); (B.A.); (J.S.L.); (M.K.N.)
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK
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Susak YM, Markulan LL, Lobanov SM, Palitsya RY, Rudyk MP, Skivka LM. Effectiveness of a new approach to minimally invasive surgery in palliative treatment of patients with distal malignant biliary obstruction. World J Gastrointest Surg 2023; 15:698-711. [PMID: 37206076 PMCID: PMC10190736 DOI: 10.4240/wjgs.v15.i4.698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/05/2023] [Accepted: 03/06/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Palliative endoscopic biliary drainage is the primary treatment option for the management of patients with jaundice which results from distal malignant biliary obstruction (DMBO). In this group of patients, decompression of the bile duct (BD) allows for pain reduction, symptom relief, chemotherapy administration, improved quality of life, and increased survival rate. To reduce the unfavorable effects of BD decompression, minimally invasive surgical techniques require continuous improvement.
AIM To develop a technique for internal-external biliary-jejunal drainage (IEBJD) and assess its effectiveness in comparison to other minimally invasive procedures in the palliative treatment of patients with DMBO.
METHODS A retrospective analysis of prospectively collected data was performed, which included 134 patients with DMBO who underwent palliative BD decompression. Biliary-jejunal drainage was developed to divert bile from the BD directly into the initial loops of the small intestine to prevent duodeno-biliary reflux. IEBJD was carried out using percutaneous transhepatic access. Percutaneous transhepatic biliary drainage (PTBD), endoscopic retrograde biliary stenting (ERBS), and internal-external transpapillary biliary drainage (IETBD) were used for the treatment of study patients. Endpoints of the study were the clinical success of the procedure, the frequency and nature of complications, and the cumulative survival rate.
RESULTS There were no significant differences in the frequency of minor complications between the study groups. Significant complications occurred in 5 (17.2%) patients in the IEBJD group, in 16 (64.0%) in the ERBS group, in 9 (47.4%) in the IETBD group, and in 12 (17.4%) in the PTBD group. Cholangitis was the most common severe complication. In the IEBJD group, the course of cholangitis was characterized by a delayed onset and shorter duration as compared to other study groups. The cumulative survival rate of patients who underwent IEBJD was 2.6 times higher in comparison to those of the PTBD and IETBD groups and 20% higher in comparison to that of the ERBS group.
CONCLUSION IEBJD has advantages over other minimally invasive BD decompression techniques and can be recommended for the palliative treatment of patients with DMBO.
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Affiliation(s)
- Yaroslav M Susak
- Department of Surgery with the Course of Emergency and Vascular Surgery, O.O. Bogomolets National Medical University, Kyiv 01601, Ukraine
| | - Leonid L Markulan
- Department of Surgery with the Course of Emergency and Vascular Surgery, O.O. Bogomolets National Medical University, Kyiv 01601, Ukraine
| | - Serhii M Lobanov
- Department of Surgery with the Course of Emergency and Vascular Surgery, O.O. Bogomolets National Medical University, Kyiv 01601, Ukraine
| | - Roman Y Palitsya
- Department of Abdominal Surgery, National Military Medical Clinical Centre “Main Military Clinical Hospital”, Kyiv 01133, Ukraine
| | - Mariia P Rudyk
- Department of Microbiology and Immunology, Taras Shevchenko National University of Kyiv, Kyiv 01033, Ukraine
| | - Larysa M Skivka
- Department of Microbiology and Immunology, Taras Shevchenko National University of Kyiv, Kyiv 01033, Ukraine
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12
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Ljubicic L, Petrovic I, Crkvenac Gregorek A, Silovski H. Portomesenteric Reconstruction during Whipple Procedure Using Autologous Left Renal Vein Patch Graft in a Patient with a Gastric Cancer Recurrence. Case Rep Surg 2023; 2023:2717041. [PMID: 37151817 PMCID: PMC10159741 DOI: 10.1155/2023/2717041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/02/2023] [Accepted: 04/11/2023] [Indexed: 05/09/2023] Open
Abstract
The case of vascular reconstruction of the superior mesenteric and portal vein confluence using a left renal vein (LRV) graft has been researched in this paper. The patient was a 66-year-old female who presented with features of biliary obstruction. A contrast-enhanced computed tomography scan revealed bile duct dilatation and a common bile duct tumor mass. Four years ago, she underwent stomach resection with subsequent Billroth II gastrojejunostomy due to gastric cancer. After surgical resection, on histopathological and immunohistochemistry examination, a recurrence of previously resected poorly cohesive gastric cancer was found.
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Affiliation(s)
- Lidija Ljubicic
- Department for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Igor Petrovic
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Hrvoje Silovski
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Farooqu W, Penninga L, Burgdorf SK, Krohn PS, Storkholm JH, Hansen CP. Relieving the bile ducts prior to pancreatoduodenectomy – A retrospective cohort study. Ann Med Surg (Lond) 2022; 84:104894. [DOI: 10.1016/j.amsu.2022.104894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/08/2022] [Accepted: 11/06/2022] [Indexed: 11/14/2022] Open
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Balogun OS, Atoyebi OA. Management of Malignant Obstructive Jaundice: Defining the Relevance of Various Palliative Surgical Options in Resource-Challenged Settings: A Review Article. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:111-119. [PMID: 36388748 PMCID: PMC9641745 DOI: 10.4103/jwas.jwas_22_22] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/31/2022] [Indexed: 06/16/2023]
Abstract
Malignant obstructive jaundice (MOJ) constitutes an important surgical problem with high morbidity and mortality worldwide. Presentation is usually delayed with a majority of patients benefitting only from palliative treatment. Surgeons practicing in developing countries face herculean task in managing MOJ due to lack of minimally invasive endoscopic procedures. Palliative surgical procedures are associated with high morbidity and sometimes mortality. Abdominal pain, generalized pruritus, and gastric outlet obstruction are some of the symptoms of MOJ requiring palliation. Successful surgical palliation may improve the overall quality of life in patients with MOJ considered fit for surgery. Bypass procedures and regional nerve blocks constitute the most effective surgical palliation available to surgeons practicing in resource-limited settings. This review article discusses the indications, the role, and types of surgical bypass procedures in the management of MOJ in contemporary surgical practice. This is important for surgeons in countries where expertise and resources for the less morbid endoscopic and radiologic approaches are not available. Relevant articles up to January 2021 published in PubMed, Google Scholar, and Hinari on the surgical management of obstructive jaundice were reviewed for inclusion. We also reviewed some modern surgical textbook topics on obstructive jaundice.
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Deng X, Liao R, Pan L, Du C, Wu Q. Second endoscopic retrograde cholangiopancreatography after failure of initial biliary cannulation: A single institution retrospective experience. Exp Ther Med 2022; 23:297. [PMID: 35340881 PMCID: PMC8931629 DOI: 10.3892/etm.2022.11226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/01/2022] [Indexed: 11/27/2022] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is not always successful when difficult biliary cannulation occurs. A second ERCP seems to be a worthwhile option following initial failure cannulation; however, relevant data are limited. Thus, the aim of the present study was to determine the outcomes of repeating ERCP in patients in whom the first biliary cannulation with or without precut sphincterotomy failed. It retrospectively analyzed 4,136 patients who underwent an initial biliary access between June 2016 and September 2020. Data from our databases were analyzed. Efficacy was based on the cannulation rate of the second ERCP and safety was assessed in terms of adverse events. Of 94 patients, 56 (59.6%) underwent a second ERCP and the success rate in biliary cannulation was 83.9% (47 of 56). The median operative time in the second ERCP was shorter than that in the initial procedure (47 vs. 65 min, P<0.001). A total of 5 patients (8.9%) suffered from mild ERCP-associated complications following the second ERCP. Compared with patients that did not undergo a second ERCP, patients that underwent a second ERCP had a lower 30-day mortality rate (13.2 vs. 1.8%, P=0.038). In addition, by univariate and multivariate analysis, it was observed that normal preoperative serum bilirubin levels and an interval time of <3 days were correlated with the cannulation failure of a second ERCP (OR=9.211, P=0.019, OR=6.765, P=0.041, respectively). A second ERCP following failure of an initial biliary cannulation appears to be safe and effective. For most clinically stable patients with an unsuccessful initial ERCP, a second ERCP after 2-4 days may be an optimal strategy. Preoperative normal serum bilirubin levels may be a risk factor that can be used for predicting cannulation failure of a second ERCP procedure.
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Affiliation(s)
- Xin Deng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Rui Liao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Long Pan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Chengyou Du
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Qiao Wu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
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Percutaneous transhepatic treatment for biliary stricture after duct-to-duct biliary anastomosis in living donor liver transplantation: a 9-year single-center experience. Eur Radiol 2022; 32:2414-2425. [DOI: 10.1007/s00330-021-08373-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/09/2021] [Accepted: 09/30/2021] [Indexed: 02/07/2023]
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Madhusudhan KS, Jineesh V, Keshava SN. Indian College of Radiology and Imaging Evidence-Based Guidelines for Percutaneous Image-Guided Biliary Procedures. Indian J Radiol Imaging 2021; 31:421-440. [PMID: 34556927 PMCID: PMC8448229 DOI: 10.1055/s-0041-1734222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Percutaneous biliary interventions are among the commonly performed nonvascular radiological interventions. Most common of these interventions is the percutaneous transhepatic biliary drainage for malignant biliary obstruction. Other biliary procedures performed include percutaneous cholecystostomy, biliary stenting, drainage for bile leaks, and various procedures like balloon dilatation, stenting, and large-bore catheter drainage for bilioenteric or post-transplant anastomotic strictures. Although these procedures are being performed for ages, no standard guidelines have been formulated. This article attempts at preparing guidelines for performing various percutaneous image-guided biliary procedures along with discussion on the published evidence in this field.
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Affiliation(s)
| | - Valakkada Jineesh
- Department of Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology (Thiruvananthapuram), Kerala, India
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Lo MH, Lin CH, Wu CH, Tsou YK, Lee MH, Sung KF, Liu NJ. Management of biliary diseases after the failure of initial needle knife precut sphincterotomy for biliary cannulation. Sci Rep 2021; 11:14968. [PMID: 34294788 PMCID: PMC8298459 DOI: 10.1038/s41598-021-94361-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/05/2021] [Indexed: 02/08/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography is not always successful even with needle knife precut sphincterotomy (NKPS). How to manage these patients with initial NKPS failure has not been well studied. We report the outcomes of patients who received endoscopic and non-endoscopic rescue treatment after the initial NKPS failure. During the 15 years from 2004 to 2018, 87 patients with initial NKPS failure received interval endoscopic treatment (IET group, n = 43), percutaneous transhepatic biliary drainage (PTBD group, n = 25), or bile duct surgery (BDS group, n = 19) were retrospectively studied. Compared with the PTBD group, the prevalence of choledocholithiasis was higher (69.8% vs. 16.0%, p < 0.001), and malignant bile duct stricture were lower (20.9% vs. 76.0%, p < 0.001) in the IET group. Furthermore, the IET group had a significantly longer time interval between the first and second treatment procedures (4 days vs. 2 days, p = 0.001), a lower technique success rate (79.1% vs. 100%, p = 0.021), and a shorter length of hospital stay (7 days vs. 18 days, p < 0.001). Compared to the BDS group, the only significant finding was that the patients in the IET group were older. Although not statistically significant, the complication rate was lowest in the IET group (7.0%) while highest in the BDS group (15.8%). Complications in the IET group were also mild, as compared with the other two groups. In conclusion, IET should be considered after initial failed NKPS for deep biliary cannulation before contemplating more invasive treatment such as BDS. PTBD may be the alternative therapy for patients with malignant biliary obstruction.
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Affiliation(s)
- Min-Hao Lo
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 5 Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan
| | - Cheng-Hui Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 5 Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan
| | - Chi-Huan Wu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 5 Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan
| | - Yung-Kuan Tsou
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 5 Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan.
| | - Mu-Hsien Lee
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 5 Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan
| | - Kai-Feng Sung
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 5 Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan
| | - Nai-Jen Liu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 5 Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan
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Guardado NV, Llorente K, Blondeau B. Evaluation and Management of Malignant Biliary Obstruction. Surg Oncol Clin N Am 2021; 30:491-503. [PMID: 34053664 DOI: 10.1016/j.soc.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
There is no reason to be pollyannaish when approaching patients with malignant biliary obstruction (MBO). Although technology has allowed refining diagnosis and resectability of cancers causing biliary obstruction, outcomes have not improved significantly. The previous preponderant place of surgical procedures now is replaced by endoluminal and percutaneous techniques for the management of symptoms of MBO. Because quantity of life often is the primary and sole outcome for evaluation of various interventions, the main focus of patient quality of life may be erroneously deemphasized. Lagging behind scientific advances are the availability of palliative care services and studies of patient-related outcomes.
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Affiliation(s)
- Nadia V Guardado
- Department of Surgery, University of New Mexico School of Medicine, 2425 Camino de Salud, Albuquerque, NM 87106, USA
| | - Kaysey Llorente
- Department of Surgery, University of New Mexico School of Medicine, 2425 Camino de Salud, Albuquerque, NM 87106, USA
| | - Benoit Blondeau
- Department of Surgery, Division of Trauma Surgery, University of New Mexico; Division of Palliative Medicine, University of New Mexico, Albuquerque, NM, USA.
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Сусак Я, Маркулан Л, Палица Р. External-Internal Biliary-Jejunal Drainage in Palliative Treatment of Distal Mechanical Jaundice. ХИРУРГИЯ. ВОСТОЧНАЯ ЕВРОПА 2021:205-219. [DOI: 10.34883/pi.2021.10.2.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2025]
Abstract
Введение. Метод выбора дренирования желчных протоков у пациентов с дистальной злокачественной механической желтухой (ДЗМЖ) остается дискуссионным.Цель. Разработать и внедрить в клиническую практику методику наружно-внутреннего билиарно-еюнального дренирования и сравнить ее результаты с ретроградным эндоскопическим стентированием при паллиативном лечении дистальной механической желтухи.Материалы и методы. В проспективное исследование вошло 54 пациента с ДЗМЖ: 29 пациентам выполнена разработанная методика наружно-внутреннего билиарно-еюнального дренирования (группа НВБЕД); 25 – эндоскопическое ретроградное билиарное стентирование (группа ЭРБС) с использованием непокрытых металлических стентов. НВБЕД проводилась с использованием предложенного дренажа, устанавливаемого посредством чрескожного чреспеченочного доступа, при этом конец дренажа с дистальной группой боковых отверстий размещался в начальных петлях еюнум, проксимальная группа боковых отверстий – в расширенных желчных протоках над стенозом.Точками исследования были клинический успех процедуры, частота и характер осложнений, накопленная выживаемость, накопленное время проходимости стента.Результаты. Клинический успех процедуры достигнут в группе НВБЕД у 82,1% пациентов, в группе ЭРБС – у 84,0% (р>0,05).В группе НВБЕД осложнения возникли у 5 (17,9%) пациентов, в группе ЭРБС – у 16 (64,0%) (р=0,002), в том числе холангит – у 10,3% против 36,0% (р=0,024) и панкреатит у 6,9%, против 36,0% (р=0,023) соответственно.При использовании НВБЕД накопленное выживание составило 252,3 дня (95% ДИ: 207,5–297,1) против 203,3 дня (95% ДИ: 164,5–242,1) в группе ЭРБС (р=0,072). Это мы связываем со снижением частоты холангита в группе НВБЕД. В целом накопленное выживание составило 248,9 дня (95% ДИ: 212,2–285,5) при отсутствии у пациентов эпизодов холангита против 168,8 дня (95% ДИ: 132,3–205,4) при наличии холангита (р=0,005).У пациентов с холангитом накопленное время проходимости стентов составляло 157,1 дня (95% ДИ: 132,1–182,1), при отсутствии холангита – 269,6 дня (95% ДИ: 230,3–309,0), р=0,005. У пациентов с НВБЕД закупорки просвета дренажа не наблюдали.Заключение. Предложенная методика наружно-внутреннего билиарно-еюнального дренирования при паллиативном лечении дистальной механической желтухи предпочтительнее эндоскопического ретроградного билиарного стентирования.
Introduction. The choice of bile duct drainage in patients with distal malignant obstructive jaundice (DMOJ) remains controversial.Purpose. To develop and introduce into clinical practice a technique for external-internal biliary- jejunal drainage and compare its results with retrograde endoscopic stenting in palliative treatment of DMOJ.Materials and methods. The prospective study included 54 patients with DMOJ: 29 patients underwent the developed method of external-internal biliary-jejunal drainage (NVBED group); 25 – endoscopic retrograde biliary stenting (ERPS group) using metal stents. NVBED was carried out using the proposed drainage installed by means of a percutaneous transhepatic approach, while the end of the drainage with the distal group of lateral holes was located in the initial loops of the jejunum, the proximal group of lateral holes – in the dilated bile ducts above the stenosis.The points of the study were the clinical success of the procedure, frequency and nature of complications, accumulated survival rate, accumulated time of stent patency.Results. Clinical success of the procedure was achieved in 82.1% of patients in the NVBED group, and 84.0% of patients in the ERHD group, p>0.05.In the IVBED group, complications occurred in 5 (17.9%) patients, in the ERHD group – in 16 (64.0%) patients, p=0.002, including cholangitis – in 10.3% versus 36.0% (p=0.024) and pancreatitis – in 6.9% versus 36.0% (p=0.023), respectively.When using NVBED, the cumulative survival was 252.3 days (95% CI: 207.5–297.1) versus 203.3 days (95% CI: 164.5–242.1) in the ERBS group (p=0.072). We associate this with the decrease of the incidence of cholangitis in the IVBED group. Thus, the overall cumulative survival was 248.9 days (95% CI: 212.2–285.5) in the absence of cholangitis episodes versus 168.8 days (95% CI: 132.3–205.4) in the presence of cholangitis, p=0.005.In patients with cholangitis, the cumulative time of stent patency was 157.1 days (95% CI: 132.1– 182.1); in the absence of cholangitis – 269.6 days (95% CI: 230.3–309.0, p=0.005. In patients with NVBED, the drainage lumen blockage was not observed.Conclusion. The proposed method of external-internal biliary-jejunal drainage for palliative treatment of distal obstructive jaundice is preferable in comparison with endoscopic retrograde biliary stenting.
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Behera RK, Srivastava DN, Kumar P, Pal S, Ranjan N, Garg P, Sahni P, Madhusudhan KS. Right-sided versus left-sided percutaneous transhepatic biliary drainage in the management of malignant biliary obstruction: a randomized controlled study. Abdom Radiol (NY) 2021; 46:768-775. [PMID: 32700212 DOI: 10.1007/s00261-020-02651-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023]
Abstract
AIM To compare the technical difficulty, safety, radiation exposure and success rates between right-sided and left-sided percutaneous transhepatic biliary drainage (RPTBD and LPTBD) in patients with malignant biliary obstruction (MBO). MATERIALS AND METHODS Fifty patients (28 males, 22 females; mean age 51.78 years) with MBO were randomized to undergo either RPTBD or LPTBD during the study period between June 2016 and May 2018. The procedure time, fluoroscopy time, radiation doses to the operators and patients, technical success, clinical success, complications and effect on quality of life were evaluated and compared between the two groups. RESULTS Twenty-five patients were included in each group. The technical success was 100% in both groups. There was no significant difference between RPTBD and LPTBD groups in terms of major complications [4% and 12%, respectively; p = 0.297] and minor complications [40% and 32%, respectively; p = 0.597]. Further, the average procedure time (37.80 ± 13.07 min vs 41.04 ± 14.94 min), fluoroscopy time (5.88 ± 4.2 min vs 5.97 ± 3.8 min), radiation doses to the operator (136.84 ± 106.67 μSv vs 130.40 ± 106.46 μSv) and to the patient (8.23 ± 5.80 Gycm2 vs 11.74 ± 11.28 Gycm2) were not significantly different between the groups. Clinical success was achieved in 21 patients (84%) of RPTBD group and 17 patients (68%) of LPTBD group with no significant difference (p = 0.416) between them. CONCLUSION There was no significant difference between RPTBD and LPTBD with reference to the technique, safety, radiation dose, success rates and impact on quality of life suggesting no laterality advantage for biliary drainage in cases of MBO.
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Percutaneous Transhepatic Cholangiography, Percutaneous Biliary Drainage and Metallic Endoprotesis Applications in Malign Biliary Obstructions. JOURNAL OF CONTEMPORARY MEDICINE 2020. [DOI: 10.16899/jcm.764141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Uysal A, Unal E, Karaosmanoglu AD, Arellano R, Ciftci TT, Akinci D, Akhan O. The role of interventional radiology in the treatment of patients with pancreatic cancer. Br J Radiol 2020; 94:20200702. [PMID: 33156695 DOI: 10.1259/bjr.20200702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Interventional radiology (IR) provides minimally invasive therapeutic and palliative options for the treatment of pancreatic cancer depending on the stage of the disease. IR plays a critical, and also a very effective role, in both pre- and post-operative care of the patients with early stage resectable disease and also in palliative treatment of the patients with locally advanced or metastatic disease. In this article, we aimed to present the capability and the limitations of IR procedures including: local treatment options of primary and metastatic pancreatic cancer, palliation of biliary and intestinal obstructions, minimally invasive treatment of post-operative complications, and pain management.
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Affiliation(s)
- Aycan Uysal
- Department of Radiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Emre Unal
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | | | - Ronald Arellano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Turkmen Turan Ciftci
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Devrim Akinci
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Okan Akhan
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
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Le TB. Percutaneous Transhepatic Intervention for Malignant Biliary Obstruction. J Clin Med 2020. [DOI: 10.38103/jcmhch.2020.64.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Biliary obstruction is a serious clinical condition resulting from either benign or malignant etiologies. For malignant obstruction, curative resection is rarely performed due to disease progression, thus decompression drainage is the management of choice. Percutaneous transhepatic drainage and stenting are effective alternative treatments to surgical bypass and endoscopic biliary drainage when these two modalities are contraindicated. Percutaneous biliary intervention is safe and effective in both drainage and restoration of bile flow with high successful rate and acceptable risk of complication. Multidisciplinary approach, proper patient selection, careful image review and comprehensive knowledge of available techniques, success rates and complications are utmost importance for a successful procedure.
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Guidelines for Management of Urgent Symptoms in Patients with Cholangiocarcinoma and Biliary Stents or Catheters using the Modified RAND/UCLA Delphi Process. Cancers (Basel) 2020; 12:cancers12092375. [PMID: 32825784 PMCID: PMC7565442 DOI: 10.3390/cancers12092375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/04/2020] [Accepted: 08/17/2020] [Indexed: 12/28/2022] Open
Abstract
Background: Patients with cholangiocarcinoma often have indwelling biliary stents or catheters which are prone to obstructions and/or infections; studies show that 20–40% present with fever and/or jaundice requiring urgent treatment in the outpatient setting for which there are no uniform guidelines. The goal was to develop an expert panel consensus on this topic using the modified RAND/UCLA Delphi process to rate treatment appropriateness. Methods: Thirteen expert physicians from relevant specialties, geography, and practice settings were recruited for the panel. Patient scenarios were developed and panelists rated the therapies before and after a face-to-face discussion. The appropriateness of various therapies was rated on a scale from 1–9 and classified as appropriate, inappropriate, or uncertain. Scenarios with greater than 2 (>2) ratings of 1–3 (inappropriate) and greater than 2 (>2) ratings of 7–9 (appropriate) were considered to have disagreement and were not assigned an appropriateness rating. Results: Panelists were from all US regions and the UK (8%) and had practiced for a mean 16.5 years (4–33 years). Panelists rated 480 scenarios before the meeting and re-rated 288 of the clinical scenarios after the meeting. The panelists agreed that ongoing treatment with chemotherapy did not influence decision-making and, therefore, 192 scenarios were excluded from the final list. Disagreement decreased from 37.5% before to 10.4% after the meeting. Consensus on stent/tube manipulation and inpatient antibiotic therapy was obtained and summarized in patients as “appropriate” or “maybe appropriate” based on a patient’s bilirubin level at presentation. Conclusions: The Delphi process produced consensus guidelines to fill an unmet need in the urgent management of ascending cholangitis in patients with cholangiocarcinoma.
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Yang G, Xiong Y, Sun J, Tang T, Li W, Wang G, Li J. Effects of different preoperative biliary drainage methods for resected malignant obstruction jaundice on the incidence rate of implantation metastasis: A meta-analysis. Oncol Lett 2020; 20:2217-2224. [PMID: 32782538 PMCID: PMC7400856 DOI: 10.3892/ol.2020.11767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 05/27/2020] [Indexed: 11/19/2022] Open
Abstract
The aim of the present study was to compare the effects of percutaneous transhepatic biliary drainage (PTBD) and endoscopic biliary drainage (EBD) for resected malignant obstruction jaundice (MOJ) on the incidence rate of implantation metastasis. Databases including PubMed, EMbase, Web of Science and Cochrane Library were utilized. With reference to literature reported until January 2019, controlled clinical trials were designed to compare the effects of PTBD and EBD for MOJ on the incidence rate of implantation metastasis. Subsequently, odds ratio (OR) with 95% confidence interval (CI) was calculated with Review Manager 5.3.0 software. A total of 10 studies were enrolled in this meta-analysis, including 1,085 cases in the PTBD group and 1,379 cases in the EBD group. The results revealed that there was a significant difference in the incidence rate of implantation metastasis between the PTBD group and EBD group (OR=0.35, 95% CI: 0.23–0.53, P<0.00001). Subgroup analysis revealed that the incidence rates of both catheter-related implantation metastasis and peritoneal metastasis were lower in the EBD group (OR=0.23, 95% CI: 0.12–0.44, P<0.00001; OR=0.47, 95% CI: 0.31–0.74, P=0.0008, respectively), and the advantage of EBD was demonstrated in perihilar cholangiocarcinoma, distal cholangiocarcinoma and pancreatic carcinoma (OR=0.35, 95% CI: 0.17–0.74, P=0.006; OR=0.32, 95% CI: 0.17–0.60, P=0.0005; OR=0.27, 95% CI: 0.19–0.40, P<0.00001, respectively). In conclusion, this meta-analysis revealed the appropriate choice of preoperative biliary drainage for resected MOJ. The application of EBD reduced the incidence rate of implantation metastasis, however more evidence is required from future studies, to confirm the results.
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Affiliation(s)
- Gang Yang
- Department of Hepatocellular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637007, P.R. China
| | - Yongfu Xiong
- Department of Hepatocellular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637007, P.R. China.,Institute of Hepato-Biliary-Intestinal Disease, North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Ji Sun
- Department of Hepatocellular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637007, P.R. China
| | - Tao Tang
- Department of Hepatocellular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637007, P.R. China
| | - Weinan Li
- Department of Hepatocellular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637007, P.R. China
| | - Guan Wang
- Physical Examination Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637007, P.R. China
| | - Jingdong Li
- Department of Hepatocellular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637007, P.R. China.,Institute of Hepato-Biliary-Intestinal Disease, North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
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Pan T, Li MA, Mu LW, Zhu D, Qian JS, Li ZR. Stent placement with iodine-125 seeds strand effectively extends the duration of stent patency and survival in patients with unresectable malignant obstructive jaundice. Scand J Gastroenterol 2020; 55:123-128. [PMID: 31906735 DOI: 10.1080/00365521.2019.1707275] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: This study aimed to compare the treatment outcomes and safety between stent placement with or without Iodine-125 (125I) seeds strand for patients with unresectable malignant obstructive jaundice (MOJ).Methods: A total of 84 patients with unresectable MOJ treated in our hospital were retrospectively included and divided into the stent group (n = 54) undergoing biliary stent placement and the stent + seeds group (n = 30) receiving stent placement with 125I seeds strand. The therapeutic outcome, postoperative complications, duration of patient survival and stent patency were compared between groups. Kaplan-Meier survival analysis was performed to compare the duration of patient survival and stent patency between groups. Cox-regression analysis was performed to investigate predictive factors for disease-free survival and overall survival.Results: The stent + seeds group had significantly longer duration of patency (231.57 ± 256.54 vs. 110.37 ± 120.52) and overall survival (310.57 ± 330.54 vs. 173.15 ± 219.40) than the stent group (both p < .05). In addition, Kaplan-Meier survival analysis confirmed that the stent + seeds group had longer duration of patency (log-rank test, p = .001) and higher overall survival rate (log-rank test, p = .020) than the stent group. Furthermore, Cox-regression analysis demonstrated that treatment methods was an independent factor associated with disease-free survival (HR: 0.36, 95% CI: 0.19-0.70; p = .003) and overall survival (HR: 1.01, 95% CI: 1.00-1.01; p < .001).Conclusion: The stent placement with 125I seeds strand can significantly improve the primary patency rate and overall survival time in MOJ patients.
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Affiliation(s)
- Tao Pan
- Department of Interventional Radiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ming-An Li
- Department of Interventional Radiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lu-Wen Mu
- Department of Interventional Radiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Duo Zhu
- Department of Interventional Radiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie-Sheng Qian
- Department of Interventional Radiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Vascular Surgery, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zheng-Ran Li
- Department of Interventional Radiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Vascular Surgery, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Shim DJ, Gwon DI, Ko GY, Yoon HK, Sung KB. Transjugular insertion of biliary stent in patients with malignant biliary obstruction complicated by ascites with/without coagulopathy: a prospective study of 12 patients. ACTA ACUST UNITED AC 2019; 25:465-470. [PMID: 31650963 DOI: 10.5152/dir.2019.18470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE In patients with malignant biliary obstruction complicated by massive ascites, when endoscopy fails, safe routes for biliary decompression are needed as an alternative to percutaneous approach. We aimed to evaluate the safety and effectiveness of transjugular insertion of biliary stent (TIBS) in patients with malignant biliary obstruction complicated by massive ascites with or without coagulopathy. METHODS From March 2012 to December 2017, a total of 12 consecutive patients with malignant biliary obstructions treated with TIBS were enrolled in this study. Five patients had jaundice and cholangitis, while seven had jaundice only. Clinical parameters including technical and clinical success rates and complications following TIBS were evaluated. Overall survival and stent occlusion-free survival were assessed using Kaplan-Meier analysis. RESULTS The indications for transjugular approach were massive ascites with (n=2) or without (n=10) coagulopathy. TIBS was technically successful in 11 of 12 patients. Clinical success was defined as successful internal drainage and was achieved in eight patients. The mean serum bilirubin level was initially 13.9±6.3 mg/dL and decreased to 4.9±5.3 mg/dL within 1 month after stent placement (P = 0.037). Two patients had procedure-related complications (hemobilia). During the follow-up period (mean, 30 days; range, 1-146 days), all 12 patients died of disease progression. The median overall survival and stent occlusion-free survival times were 19 days (95% confidence interval [CI], 16-22 days) and 19 days (95% CI, 12-26 days), respectively. There was no stent dysfunction in the eight patients that had successful internal drainage. CONCLUSION TIBS appears to be safe, technically feasible, and clinically effective for patients with malignant biliary obstruction complicated by massive ascites with or without coagulopathy.
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Affiliation(s)
- Dong Jae Shim
- Department of Radiology, Incheon St. Mary's Hospital, The Catholic University of Korea School of Medicine, Seoul, Republic of Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Ulsan University School of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, Ulsan University School of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, Ulsan University School of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Kyu-Bo Sung
- Department of Radiology and Research Institute of Radiology, Ulsan University School of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Lesmana CRA, Gani RA, Hasan I, Sulaiman AS, Ho KY, Dhir V, Lesmana LA. Palliative Endoscopic Ultrasound Biliary Drainage for Advanced Malignant Biliary Obstruction: Should It Replace the Percutaneous Approach? Case Rep Gastroenterol 2019; 13:385-397. [PMID: 31616233 PMCID: PMC6792464 DOI: 10.1159/000502835] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/20/2019] [Indexed: 12/12/2022] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) are the standard of care in malignant biliary obstruction cases. Recently, endoscopic ultrasound-guided biliary drainage (EUS-BD) has been widely used after unsuccessful ERCP. However, the patient's clinical impact of EUS-BD over PTBD is still not obvious. Therefore, this case series study aims to evaluate the clinical outcomes of patients with advanced malignant biliary obstruction who underwent EUS-BD after failed ERCP. A retrospective database study was performed between January 2016 and June 2018 in patients with advanced malignant biliary obstruction. Patients were consecutively enrolled without randomization. Treatment options consisted of ERCP and PTBD or EUS-BD if ERCP failed. Based on 144 biliary obstruction cases, 38 patients were enrolled; 24 (63.2%) were men. The patients' mean age was 66.8 ± 12.36 years. The most common cause of malignant biliary obstruction was pancreatic cancer (44.7%). Biliary drainage was achieved by ERCP (39.5%), PTBD (39.5%), and EUS-BD (21.1%). The technical success rate was 86.7% by PTBD and 87.5% by EUS-BD (p = 1.000), while the clinical success rate was 93.3% by PTBD and 62.5% by EUS-BD (p = 0.500). The median survival in patients who underwent PTBD versus those wo underwent EUS-BD was 11 versus 3 months (log-rank p = 0.455). In conclusion, there is no significant advantage of EUS-BD when compared to PTBD in terms of clinical success and survival benefit in advanced malignant biliary obstruction.
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Affiliation(s)
- C Rinaldi A Lesmana
- Digestive Disease and Gastrointestinal Oncology Center, Medistra Hospital, Jakarta, Indonesia.,Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia
| | - Rino A Gani
- Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia
| | - Irsan Hasan
- Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia
| | - Andri Sanityoso Sulaiman
- Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia
| | - Khek Yu Ho
- Division of Gastroenterology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Vinay Dhir
- Department of Gastroenterology and Endoscopy, SL Raheja Hospital, A Fortis Associate Mahim, Mumbai, India.,Department of Gastroenterology and Endoscopy, Asian Cancer Institute, Somaiya Ayurvihar, Mumbai, India
| | - Laurentius A Lesmana
- Digestive Disease and Gastrointestinal Oncology Center, Medistra Hospital, Jakarta, Indonesia
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30
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Lamanna A, Maingard J, Bates D, Ranatunga D, Goodwin M. Percutaneous transhepatic laser lithotripsy for intrahepatic cholelithiasis: A technical report. J Med Imaging Radiat Oncol 2019; 63:758-764. [PMID: 31545020 DOI: 10.1111/1754-9485.12952] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 08/17/2019] [Indexed: 01/11/2023]
Abstract
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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Affiliation(s)
- Anthony Lamanna
- Interventional Radiology Service - Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Julian Maingard
- Interventional Radiology Service - Monash Imaging, Monash Health, Melbourne, Victoria, Australia.,School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Davina Bates
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Dinesh Ranatunga
- Interventional Radiology Service - Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Mark Goodwin
- Interventional Radiology Service - Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia
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31
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Kariya CM, Wach MM, Ruff SM, Ayabe RI, Lo WM, Torres MB, Petrick JL, McNeel TS, Davis JL, McGlynn KA, Hernandez JM. Postbiliary drainage rates of cholangitis are impacted by procedural technique for patients with supra-ampullary cholangiocarcinoma: A SEER-Medicare analysis. J Surg Oncol 2019; 120:249-255. [PMID: 31044430 DOI: 10.1002/jso.25485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/10/2019] [Accepted: 04/14/2019] [Indexed: 12/14/2022]
Abstract
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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Affiliation(s)
- Christine M Kariya
- Surgical Oncology Program, National Cancer Institute, Bethesda, Maryland
| | - Michael M Wach
- Surgical Oncology Program, National Cancer Institute, Bethesda, Maryland
| | - Samantha M Ruff
- Surgical Oncology Program, National Cancer Institute, Bethesda, Maryland
| | - Reed I Ayabe
- Surgical Oncology Program, National Cancer Institute, Bethesda, Maryland
| | - Winifred M Lo
- Surgical Oncology Program, National Cancer Institute, Bethesda, Maryland
| | - Madeline B Torres
- Surgical Oncology Program, National Cancer Institute, Bethesda, Maryland
| | - Jessica L Petrick
- Metabolic Epidemiology Branch, National Cancer Institute, Rockville, Maryland
| | | | - Jeremy L Davis
- Surgical Oncology Program, National Cancer Institute, Bethesda, Maryland
| | - Katherine A McGlynn
- Metabolic Epidemiology Branch, National Cancer Institute, Rockville, Maryland
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Makary MS, Farrell JJ, Khayat M, Chick JFB, Srinivasa RN. Biliary Endoscopy for Benign and Malignant Biliary Strictures. Tech Vasc Interv Radiol 2019; 22:135-138. [PMID: 31623753 DOI: 10.1053/j.tvir.2019.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Percutaneous endoscopy operated by interventional radiologists has the potential to become an effective tool to both help diagnose and treat benign and malignant biliary strictures. This is particularly true in cases where endoscopic retrograde cholangiopancreatography fails or is not feasible due to surgically-altered anatomy. Both preoperative clinical and technical procedural factors must be taken into consideration when pursuing percutaneous endoscopy. In this article, clinical evaluation, perioperative management, and procedural techniques for biliary endoscopy for benign and malignant strictures are reviewed.
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Affiliation(s)
- Mina S Makary
- Department of Radiology, Division of Vascular and Interventional Radiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jeffrey J Farrell
- Department of Radiology, Division of Vascular and Interventional Radiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Mamdouh Khayat
- Department of Radiology, Division of Vascular and Interventional Radiology, The Ohio State University Wexner Medical Center, Columbus, OH.
| | - Jeffrey Forris Beecham Chick
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195
| | - Ravi N Srinivasa
- Department of Radiology, Division of Vascular and Interventional Radiology, UCLA Medical Center, Los Angeles, CA
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Zhao Z, Song J, Fan X, Fang S, Chen M, Chen W, Wu F, Zheng L, Tu J, Ji J. Primary Clinical Application of Y-Shaped Jogged Stent Implantation in Patients with Malignant Hilar Biliary Obstruction. J Gastrointest Surg 2019; 23:745-750. [PMID: 30790219 DOI: 10.1007/s11605-019-04131-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/21/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To assess the feasibility, safety, and efficacy of Y-shaped jogged stent in patients with malignant hilar biliary obstruction. METHODS A total of 196 patients with malignant hilar biliary obstruction treated by biliary tract stent implantation from August 2010 to August 2017 were retrospectively reviewed. Seventeen consecutive patients who were treated with Y-shaped jogged stent implantation were identified as the Y-shaped jogged stent implantation group. Seventeen matched patients undergoing unilateral stent placement combined with percutaneous transhepatic cholangial drainage (PTCD) were enrolled as the control group. Baseline characteristics of patients, stent patency time, and survival time were compared. RESULTS There was no significant difference in the age, gender, tumor type and stage, biliary obstruction classification, bilirubin level at diagnosis, presence of metastasis, or chemotherapy between the Y-stent group and the control group (P > 0.05). One week after surgery, the reduction rate of bilirubin was significantly higher in the Y-stent group (88.2% vs 53.0%, P < 0.05). The mean stent patency time was longer in the Y-stent group (7.3 ± 1.0 months vs 5.7 ± 0.9 months, P < 0.05). The mean survival time of the Y-stent group (9.1 ± 1.5 months) was longer than the control group (7.2 ± 1.1 months, P > 0.05). There was no severe complication occurred in both two groups. CONCLUSION Y-shaped jogged stent implantation was a safe, feasible, and effective approach in the treatment of patients with malignant hilar biliary obstruction, with the significantly prolonged stent patency time and survival time.
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Affiliation(s)
- Zhongwei Zhao
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, No. 289 Kuocang Road, Lishui, 323000, Zhejiang, People's Republic of China
| | - Jingjing Song
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, No. 289 Kuocang Road, Lishui, 323000, Zhejiang, People's Republic of China
| | - Xiaoxi Fan
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, No. 289 Kuocang Road, Lishui, 323000, Zhejiang, People's Republic of China
| | - Shiji Fang
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, No. 289 Kuocang Road, Lishui, 323000, Zhejiang, People's Republic of China
| | - Minjiang Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, No. 289 Kuocang Road, Lishui, 323000, Zhejiang, People's Republic of China
| | - Weiqian Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, No. 289 Kuocang Road, Lishui, 323000, Zhejiang, People's Republic of China
| | - Fazong Wu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, No. 289 Kuocang Road, Lishui, 323000, Zhejiang, People's Republic of China
| | - Liyun Zheng
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, No. 289 Kuocang Road, Lishui, 323000, Zhejiang, People's Republic of China
| | - Jianfei Tu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, No. 289 Kuocang Road, Lishui, 323000, Zhejiang, People's Republic of China
| | - Jiansong Ji
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China.
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, No. 289 Kuocang Road, Lishui, 323000, Zhejiang, People's Republic of China.
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Zhou WZ, Fu YM, Yang ZQ, Shi HB, Liu S, Xia JG, Zhou CG. Study of Percutaneous Stent Placement with Iodine-125 Seed Strand for Malignant Biliary Obstruction. Cardiovasc Intervent Radiol 2019; 42:268-275. [PMID: 30506169 DOI: 10.1007/s00270-018-2117-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/08/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the effectiveness and safety of simultaneous placement of a self-expandable metallic stents (SEMS) and iodine-125 seed strand in the management of malignant obstructive jaundice (MOJ). MATERIALS AND METHODS This study included 132 patients with MOJ treated from November 2015 to October 2017. Forty-five patients underwent insertion of SEMS with iodine-125 seed strands (Seeds group); the remaining 87 patients underwent SEMS placement alone (Control group). Technical success was defined as accurate, successful deployment of SEMS with or without iodine-125 seed strand; clinical success was defined as 20% reduction in serum bilirubin within 1 week after the procedure, compared with baseline. Complications, duration of primary stent patency, and overall survival were evaluated. RESULTS Technical success was achieved in all patients in both groups. In the Seeds group, an average of 14 seeds (range 8-22) were implanted in the bile duct as a strand. Clinical success rates were similar between the groups (Seeds group, 93.3%; Control group, 95.4%). Major complications occurred in only one patient, in the Control group. The median period of primary stent patency was significantly longer in the Seeds group (194 days) than in the Control group (86 days; P = 0.049). The median overall survival was also significantly longer in the Seeds group (194 days) than in the Control group (96 days; P = 0.031). CONCLUSION SEMS combined with iodine-125 seed strands is effective and safe in the management of MOJ and can improve stent patency and patient survival.
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Affiliation(s)
- Wei-Zhong Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Yong-Meng Fu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Zheng-Qiang Yang
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China.
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Jin-Guo Xia
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Chun-Gao Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
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Iacobellis F, Perillo A, Iadevito I, Tanga M, Romano L, Grassi R, Nicola R, Scaglione M. Imaging of Oncologic Emergencies. Semin Ultrasound CT MR 2017; 39:151-166. [PMID: 29571552 DOI: 10.1053/j.sult.2017.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Oncologic emergencies can be either the result of the primary tumor, its metastasis, a paraneoplastic syndrome or reaction to the chemotherapy. Imaging plays a crucial role in ensuring a prompt diagnosis as well as assisting in the therapeutic management. In this article, we discuss the common thoracic and abdominal oncological emergencies that may be encountered in an emergency department.
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Affiliation(s)
- Francesca Iacobellis
- Department of Radiology, "Pineta Grande" Hospital, Castel Volturno (CE), Italy; Department of Radiology, "A. Cardarelli" Hospital, Naples, Italy; Department of Radiology, University of Campania "L. Vanvitelli", Naples, Italy
| | - Alessandra Perillo
- Department of Radiology, "Pineta Grande" Hospital, Castel Volturno (CE), Italy; Department of Radiology, University of Campania "L. Vanvitelli", Naples, Italy
| | - Isabella Iadevito
- Department of Radiology, "Pineta Grande" Hospital, Castel Volturno (CE), Italy
| | - Michela Tanga
- Department of Radiology, "Pineta Grande" Hospital, Castel Volturno (CE), Italy
| | - Luigia Romano
- Department of Radiology, "A. Cardarelli" Hospital, Naples, Italy
| | - Roberto Grassi
- Department of Radiology, University of Campania "L. Vanvitelli", Naples, Italy
| | - Refky Nicola
- Department of Radiology, SUNY-Upstate University and Medical Center, Syracuse, NY
| | - Mariano Scaglione
- Department of Radiology, "Pineta Grande" Hospital, Castel Volturno (CE), Italy; Department of Radiology, Sunderland Royal Hospital, NHS, Sunderland, UK.
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Deipolyi AR, Covey AM. Palliative Percutaneous Biliary Interventions in Malignant High Bile Duct Obstruction. Semin Intervent Radiol 2017; 34:361-368. [PMID: 29249860 DOI: 10.1055/s-0037-1608827] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The optimal palliative intervention for malignant biliary obstruction is internal drainage by placement of a metallic stent. For patients with hilar biliary obstruction or low bile duct obstruction in whom endoscopy is not feasible, a percutaneous transhepatic approach in interventional radiology is preferred. This article reviews the rationale for this approach, periprocedural management, and techniques to optimize stent patency.
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Affiliation(s)
- Amy R Deipolyi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, New York, New York
| | - Anne M Covey
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, New York, New York
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Mao XN, Lu ZM, Wen F, Liang HY, Guo QY. Bare-metal stents across the Vater's ampulla is a safe method for patients with lower bile duct obstruction. Medicine (Baltimore) 2017; 96:e7475. [PMID: 29137005 PMCID: PMC5690698 DOI: 10.1097/md.0000000000007475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study explored the effect of the implant position of stents across the Vater's ampulla on treatment outcomes in patients with lower bile duct obstruction.In the retrospective study, 41 patients with malignant obstruction of the lower bile duct and obstructive jaundice received percutaneous transhepatic biliary placement of bare-metal stents. Basic demographic data on patients, such as sex, age, and primary diseases, and follow-up data, including postoperative complications and jaundice-free survival, were recorded. The follow-up data on patients with an involved ampulla, patients with an uninvolved ampulla, patients with a stent across the ampulla, and patients with a stent at a site other than the ampulla were compared. Furthermore, prognostic factors for jaundice- free survival were investigated using Cox proportional hazards regression analysis.Among the 41 patients, 38 patients experienced subsiding of jaundice, whereas 3 cases had unsuccessful stent patency. Whether or not the ampulla was involved did not influence the incidence rates of postoperative complications and the jaundice-free survival time. Notably, when stents were placed across the ampulla, the jaundice-free survival time was significantly longer than when stents were placed at sites other than across the ampulla (P < .05). Furthermore, placement of the stent across the ampulla or at other sites was an independent prognostic factor (hazard ratio = 0.154, 95% confidence interval 0.042-0.560, P = .005) for jaundice-free survival of patients.The current study revealed that the implant position of a stent across the ampulla resulted in maintenance of stent patency and prolongation of the jaundice-free survival time.
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梁 运, 黄 鹏, 农 兵. 肝外胆管梗阻的支架治疗研究进展. Shijie Huaren Xiaohua Zazhi 2017; 25:1173-1178. [DOI: 10.11569/wcjd.v25.i13.1173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
胆管支架治疗肝外胆管梗阻已经是当前内镜下治疗的研究热点. 肝外胆管梗阻的常见病因有: 胆管结石、胆管慢性炎症狭窄、胆管恶性肿瘤、壶腹部肿瘤、肝门部胆管癌、慢性胰腺炎、胰头癌等. 胆管支架治疗可以是恶性肿瘤的姑息性退黄治疗, 也可以是外科手术前的暂时性退黄治疗或不宜手术患者的对症治疗. 但是关于胆管支架治疗肝外梗阻目前国内未有一致意见的报道, 统一标准的缺失使得临床的诊治工作仍面临重大的挑战.
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