Endoscopic retrograde cholangiopancreatographic evaluation of patients with obstructive jaundice

Department of Medicine, DHQ/RMC Hospital, Raja Bazar, Rawalpindi.
Journal of the College of Physicians and Surgeons--Pakistan: JCPSP (Impact Factor: 0.35). 07/2003; 13(6):325-8.
Source: PubMed


To evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) in patients with obstructive jaundice.
A retrospective, observational study.
The study was carried out at Valley Clinic, Rawalpindi, from January 1999 to January 2002.
Two-hundred and twenty-six patients, who underwent ERCP for evaluation of obstructive jaundice were included. ERCP in each case was performed with standard technique and the findings were recorded. Therapeutic procedures like sphincterotomy, Dormia extraction for stone, and stent placements were performed whenever indicated.
Of the 226 patients, 117 (51.8%) were males, and 109 (48.2%) females, their mean age being 51.8+/-16.6 years. Common bile and pancreatic ducts were visualized in 81.8% and 68.1% patients respectively. Growth/masses and stones were commonest causes of obstructive jaundice. Choledocholithias was common in males, while biliary channel related growth/masses were common in females (p-value=0.03). Common bile duct stone clearance rate was 88%, stenting was highly successful in patients with growth and strictures. ERCP related complications were noted in 11 (4.8%) patients.
ERCP is an important diagnostic and therapeutic modality for evaluation of patients with obstructive jaundice. Growth/masses and stones are common causes of obstructive jaundice which can be diagnosed and treated with ERCP.

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    • "A vast array of invasive and non invasive diagnostic tests is available to diagnose and establish the etiology of surgical obstructive jaundice [4,7]. Invasive tests may cause cholangitis and imaging techniques like computed tomography (CT) scan, PTC, ERCP and MRCP are expensive and are not readily available in most centers in developing countries [7-10], and ultrasonography remains the only diagnostic test available [4,11]. "
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    ABSTRACT: Obstructive jaundice poses diagnostic and therapeutic challenges to general surgeons practicing in resource-limited countries. This study was undertaken to highlight the etiological spectrum, treatment outcome of obstructive jaundice in our setting and to identify prognostic factors for morbidity and mortality. This was a descriptive prospective study which was conducted at Bugando Medical Centre between July 2006 and June 2010. All patients with a clinical diagnosis of obstructive jaundice were, after informed consent for the study, consecutively enrolled into the study. Data were collected using a pre-tested structured questionnaire and analyzed using SPSS computer software version 11.5. A total of 116 patients were studied. Females outnumbered males by a ratio of 1.3:1. Patients with malignant obstructive jaundice were older than those of benign type. Ca head of pancreas was the commonest malignant cause of jaundice where as choledocholithiasis was the commonest benign cause. Abdominal ultrasound was the only diagnostic imaging done in all patients and revealed dilated intra and extra-hepatic ducts, common bile stones and abdominal masses in 56.2%, 78.9%, 58.1% and 72.4% of the cases respectively. A total of 110 (94.8%) patients underwent surgical treatment and the remaining 6 (5.2%) patients were unfit for surgery. The complication rate was 22.4% mainly surgical site infections. The mean hospital stay and mortality rate were 14.54 days and 15.5% respectively. A low haematocrit and presence of postoperative sepsis were the main predictors of the hospital stay (P < 0.001), whereas age > 60 years, prolonged duration of jaundice, malignant causes and presence of postoperative complications mainly sepsis significantly predicted mortality (P < 0.001). Obstructive jaundice in our setting is more prevalent in females and the cause is mostly malignant. The result of this study suggests that early diagnosis and treatment plays an important role in the prognosis of patients with obstructive jaundice.
    BMC Research Notes 05/2011; 4(1):147. DOI:10.1186/1756-0500-4-147

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