Endoskopische transpapilläre Gallengangsdrainage bei tumorbedingtem Verschlußikterus

Abstract

Endoscopic biliary duct drainage was performed in 54 patients with obstructive jaundice caused by papillary carcinoma (n = 4), periampullar carcinoma (n = 4), carcinoma of head of pancreas (n = 16), primary biliary duct carcinoma (n = 14), biliary bladder carcinoma (n = 14) and hilar lymph node metastases (n = 2) using a bilioduodenal endoprosthesis. Drainage was successful in 45 cases; serum bilirubin decreased rapidly, well-being improved, appetite and weight increased. The average survival time was 4.8 months. The initially high rate of complications, mainly due to cholangitis, with a mortality rate of 9.3% could be reduced drastically after use of a duodenoscope with a 3.7 mm bore instrumentation canal enabling insertion of well-draining wide-lumen endoprostheses. Drainage should only be used in non-resectable tumours, general inoperability or for preoperative relief of biliary ducts in jaundice and prospective curative surgical intervention. As results improve with mounting experience it may be expected that endoscopic biliary duct drainage will replace palliative surgery, especially in elderly patients at risk.

Current Endoscopic Management of Malignant Biliary Stricture

“…Percutaneous transhepatic biliary drainage was introduced~40 years ago [1] for the treatment of obstructive jaundice; however, the more convenient endoscopic trans-papillary drainage, which was introduced in 1981 [2,3], is more commonly used in clinical practice today. The most common malignancy diseases that can cause obstructive jaundice are cholangiocarcinoma, pancreatic cancer [4], and ampullary neoplasms.…”