Treatment of malignant biliary obstructions via the percutaneous approach
Abteilung für Radiodiagnostik, Radiologische Klinik der Ruprecht-Karls-Universität Heidelberg.Der Radiologe (Impact Factor: 0.43). 12/2005; 45(11):1020-30.
This paper gives an overview of experience and success of percutaneous transhepatic interventions in malignant biliary obstruction. Even after exhaustion of surgical and endoscopic therapy options, the percutaneously inserted stents provide effective palliation. The palliative treatment of malignant jaundice using a stent is an established procedure in clinical practice, particularly whenever the endoscopic, transpapillary approach is not possible due to high obstructions or previous surgery. The technical success rate is very high (about 95-100%), and the complication rate is about 10-30%. Since the patency rate of stents is higher than that of plastic endoprostheses, their primary use is justified despite higher costs, provided the patients are adequately selected.
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ABSTRACT: In this study, we determined whether preoperative biliary drainage should be routinely performed in patients with jaundice. The 342 patients undergoing pancreaticoduodenectomy between June 2004 and June 2008 were analyzed. Of these patients, 303 without biliary drainage were divided into 4 groups: (1) no jaundice, (2) mild jaundice, (3) moderate jaundice, and (4) severe jaundice. Multiple preoperative, intraoperative, and postoperative variables were examined. Postoperative complications were stratified by severity according to the modified Clavien classification. Patients with jaundice had a higher incidence in subsequent complications than those with no jaundice. The complications were stratified by severity. Compared with those in group 1, patients in groups 2, 3, and 4 had more complications just in grade 2 (15.6%, 23.1%, 28.3%, and 40.0%, respectively, P = 0.046), but not other more severe grades including 3a, 3b, 4a, 4b, and 5; all of the complications in this grade could be conservatively treated and cured without requiring surgical, endoscopic, or radiological intervention. The incidences of infection and overall complications were higher in patients with drainage than those without, but neither difference was statistically significant. Preoperative drainage should not routinely be performed in patients with jaundice scheduled for pancreaticoduodenectomy, and immediate surgery is preferable.Pancreas 03/2009; 38(4):379-86. DOI:10.1097/MPA.0b013e31819f638b · 2.96 Impact Factor
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ABSTRACT: Dieser Beitrag gibt eine Übersicht über den aktuellen Stellenwert der radiologischen Diagnostik und Intervention bei malignen Stenosen der Gallenwege. Maligne Stenosen werden meist durch cholangiozelluläre Karzinome, Klatskin-Tumoren, Gallenblasenkarzinome oder Pankreaskarzinome verursacht. Die perkutane Gallengangsdrainage und Stentplatzierung ist bei diesen in der Regel nicht heilbaren Patienten (kuratives Vorgehen in nur 10–20% möglich) für den erfahrenen interventionell tätigen Radiologen wenig kompliziert und mit einer Erfolgsrate von 95–100% (für Punktion, Rekanalisation und Stentplatzierung) technisch sehr erfolgreich. Sie ist indiziert, wenn endoskopisch ein transpapillärer Zugang nicht möglich ist, wie z.B nach früheren operativen Eingriffen oder bei sehr harten hilären Obstruktionen. Morbidität und Mortalität sind heute durch die technische Verbesserung der perkutanen Intervention als mit der Endoskopie vergleichbar anzusehen. This article gives a review of the current value of radiological diagnostics and interventions for malignant stenoses of the bile pathways. Malignant stenoses are mostly caused by cholangiocellular carcinoma, Klatskin’s tumor, gall bladder carcinoma or pancreatic carcinoma. Percutaneous biliary drainage and stent positioning generally for generally incurable patients (curative approach only possible in 10–20%) is an uncomplicated procedure for an experienced surgical radiologist and is technically very successful with a success rate of 95–100% (for puncture, recanalization and stent positioning). This approach is indicated when a transpapillary endoscopic access is not possible, as for example following previous operative interventions or very hard hilar obstructions. Nowadays the morbidity and mortality are comparable to endoscopy due to the technical improvements in percutaneous interventions. SchlüsselwörterMaligner Gallenwegstumor-Verschlussikterus-Cholangiographie-Drainage-Stent KeywordsCholangiocarcinoma-Jaundice-Cholangiography-Drainage-StentDer Onkologe 09/2010; 16(9):862-879. DOI:10.1007/s00761-010-1880-0 · 0.14 Impact Factor
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ABSTRACT: Percutaneous transhepatic primary biliary stenting (PS) is an alternative to the widely used staged procedure (secondary biliary stenting, SS) for treating obstructive jaundice in cancer patients. To evaluate the efficacy and safety of PS and SS, a retrospective analysis was carried out. The percutaneous biliary stenting procedures performed between January 2000 and December 2007 at one hepatobiliary center were retrospectively analyzed, comparing the technical success rates, complications, and length of hospitalization of the two procedures. Of 61 patients (mean age 65.5 ± 13.1 years; range 31.1-92.7 years) suffering from obstructive jaundice caused by primary or metastatic tumors, 30 received PS and 31 received SS. The groups were comparable in the anatomical level of the obstruction, stent configuration, or the concurrent presence of cholangitis. Placement of metallic stents required one session for patients in the PS group and an average of 2.6 ± 1.1 sessions for patients in the SS group. The overall technical success rate was 98.4% with 1 (1/61) failed approach to transcend the occlusion in the SS group. The rate of minor complications was 10% in the PS group and 6.5% in the SS group. The corresponding rates of major complications were 23.3% and 54.8%, respectively. SS patients had a higher rate of complications in general (P < 0.05), as well as a higher rate of severe complications in particular (P < 0.05). Procedural mortality was 0% for both the groups. The mean overall length of hospitalization was 7.7 ± 9.6 days for PS and 20.6 ± 19.6 days for SS (P < 0.001). Primary percutaneous biliary stenting of malignant biliary obstructions is as efficacious and safer than a staged procedure with secondary stenting. By virtue of requiring shorter hospital stays, primary stenting is likely to be more cost-effective.Indian Journal of Radiology and Imaging 02/2013; 23(1):38-45. DOI:10.4103/0971-3026.113620
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