A Three-Stage Therapeutic and Diagnostic Algorithm in Mechanical Jaundice of Different Genesis and the Most Effective Mini-Invasive Method of Its Treatment

Percutaneous transhepatic endoscopic ultrasound-guided intervention is a crucial method for addressing mechanical jaundice. This technique for restoring bile outflow enables the resolution of several medical and diagnostic issues with minimal invasiveness and fewer complications compared to traditional open surgical treatments. Most often, antegrade cholangiostomy is used in oncological practice, where the variety of clinical situations determines the indications for performing this intervention in different variants and with different goals. According to the world literature, at the moment, sufficient experience of transdermal technologies has been accumulated, their application in clinical practice has been worked out, which allows to recognize them, to a certain extent, as routine. The purpose of this work is to optimize biliary decompression in patients with tumor obstruction of the biliary tract, to improve the prevention of complications, to enhance the immediate results of treatment and the quality of life for this group of population. The study analyzed the examination and surgical treatment outcomes of 64 patients with tumor-related mechanical jaundice treated in surgical hospitals from 2017 to 2023. All patients underwent antegrade biliary drainage procedures, specifically percutaneous transhepatic cholangiostomy and bile duct stenting under ultrasound guidance, to achieve biliary decompression. Percutaneous transhepatic endoscopic interventions have become the primary method for biliary decompression in cases of bile duct obstruction due to tumors. These procedures, particularly for malignant tumors, are associated with relatively few complications and low mortality rates.

Section: обговорення одержаних результатівunclassified

Antegrade Methods of Biliary Decompression in Tumor Obstruction of the Biliary Tract

Shevchuk,

Dudchenko,

Kravtsiv

et al. 2024

“…Велика кількість суперечливих думок та даних і своєрідний статистичний «гармидер» формуються у зв'язку із великою кількістю повідомлень авторів, які володіють переважно однією із малоінвазивних технологій вирішення проблеми МЖ і відстоюють її переваги [5,6]. Аналіз літературних даних свідчить про різноманітні підходи щодо трактування невдалих спроб лікування, ускладнень та різному досвіді виконання антеградного та ретроградного біліарного дренування [7].…”

Section: полтавський державний медичний університетunclassified

Personalized Approach to the Choice of Biliary Drainage Tactics in Patients With Tumor-Induced Mechanical Jaundice

Shevchuk,

Dudchenko,

Kravtsiv

et al. 2023

Mechanical jaundice resulting from the tumor-induced obstruction of bile ducts is usually the first and quite severe complication of malignant neoplasms of the organs of the hepatopancreatoduodenal zone. Radical treatment for this condition, as reported by various sources, remains below 20-25%. Therefore, the imperative is to select the most effective minimally invasive biliary drainage method to alleviate biliary tract pressure and address the issue of mechanical jaundice. This approach serves both as a preparatory step for potential radical surgical intervention and as a definitive method for palliative treatment in this patient category. The aim of this work is to develop an optimal algorithm for diagnosis and treatment of patients with tumor-induced mechanical jaundice, which will increase the effectiveness of primary surgical intervention and reduce the number of complications and mortality for this category of patients. The investigation focused on examining the results of diagnostic and surgical interventions in 108 patients with tumor-induced mechanical jaundice. These patients underwent biliary drainage operations in surgical hospitals between 2017 and 2023. Analysis of the surgical outcomes revealed that endoscopic drainage and percutaneous transhepatic drainage exhibited similar effectiveness in I and II levels of biliary obstruction. However, endoscopic drainage demonstrated lower complication rates and improved quality of life for patients, establishing it as the preferred method. For level III blockages, percutaneous transhepatic drainage is recommended. The implementation of a diagnostic and treatment algorithm, which considers the level of biliary block, the severity of mechanical jaundice, and the tumor process stage, enables the selection of the most effective minimally invasive biliary drainage method. This approach contributes to a reduction in postoperative mortality.

“…Для продовження життя хворих із пухлинами ГПДЗ за допомогою ендобіліарного стентування необхідний активний контроль, заміна пластикового стенту через 3-4 міс., заміна пластикового стенту на нитіноловий, встановлення пластикового стенту в просвіт оклюзованого нитінолового, діатермокоагуляція, або лазерна деструкція пухлинних мас в просвіті нитінолового стенту [11]. Для загального результату лікування, окрім своєчасного ендопротезування, велике значення має комплексна консервативна терапія, в також профілактика ускладнень [6].…”

Section: таблиця 1 основні результати ендобіліарного стентуванняunclassified

Management of Tumour Obstructions of Distal Part of Common Bile Duct Using Retrograde Biliary Stenting

Shevchuk¹

2022

The aim of this study is to improve endobiliary stenting in patients with tumour obstruction of the distal part of common bile duct, as well as to promote the prevention of complications, and improve immediate results of treatment and quality of life of patients. The study included 68 patients who took the course of treatment at surgical hospitals from 2018 to 2022 and underwent endoscopic transpapillary stenting of the common bile duct for mechanical jaundice. In 37 patients, stenting was performed using a plastic stent, in 31 patients stenting was performed using a nitinol stent. Results of endobiliary stenting, complications, effectiveness and safety of stenting were evaluated. All patients underwent stening of the common bile duct. During endoscopic retrograde biliary stenting, only 5 patients had complications in the form of bleeding from the area of large duodenal papilla that was stopped endoscopically. In early postoperative period, 12 patients had following complications: migration of plastic stent into duodenum (3 cases), obturation of plastic stent (1 case), acute secondary pancreatitis (6 cases), and cholangitis (2 cases). In 64 out of 68 patients, endobiliary stenting provided satisfactory outcomes resulting in the decompression of external bile ducts. Endoscopic transpapillary stenting of common bile duct is a low-traumatic, safe and effective method of the decompression of biliary tract when it is obstructed by a tumour. Depending on the expected life expectancy we should use nitinol stents (≥ 6 months) or plastic one (of ≤ 6 months).