Fate of patients with obstructive jaundice

Abstract

BACKGROUND/OBJECTIVE: Systematic data are limited on the etiology and prognosis of unselected patients with obstructive jaundice (OJ). We aimed to review the clinical features, etiology, and prognosis of patients with OJ. METHODS: All adult patients with bilirubin ≥ 5.85 mg/dL (100 μmol/L) at a university hospital in Sweden in 2003–2004 were identified. Medical records from patients with OJ were reviewed. RESULTS: Seven hundred and forty‐nine patients were identified, of whom 241 (32%) had OJ (median age 71 years, 129 women). No one was lost to follow‐up. The biliary obstruction of 154 patients (64%) was a result of a malignancy: 69 patients (46%) had pancreatic cancer, 44 (29%) had cholangiocarcinoma (CC), 5 (3%) had papilla vateri cancers, and 36 patients (23%) had other malignancies. Of the 87 patients with a benign obstruction, 57 (65%) had choledocholithiasis, 7 (8%) had biliary strictures, 6% had PSC, and the obstruction of 16 patients (20.7%) had other causes. A total of 115 of the 242 patients (48%) had abdominal pain associated with jaundice, whereas 52% had painless jaundice. Thirty‐four percent of patients with a malignant obstruction had abdominal pain versus 71% of patients with a benign obstruction (P < .05). At the end of follow‐up, only 5% (8 patients) with a malignant obstruction were alive versus 78% with a benign obstruction. CONCLUSIONS: Obstructive jaundice was the cause of the severe jaundice of one third of patients. Most cases of OJ were a result of a malignancy, which carried a very poor prognosis, with a 2‐year mortality rate of 95%. Journal of Hospital Medicine 2008;3:117–123. © 2008 Society of Hospital Medicine.

Pre-operative biliary drainage for obstructive jaundice

“…The clinical symptoms and signs of obstructive jaundice include yellow discolouration of skin and conjunctiva, dark urine, pale stools, and pruritus. The main causes of obstructive jaundice include benign common bile duct stones or benign biliary stricture (secondary to common bile duct stones or a complication of cholecystectomy) and malignancy due to periampullary cancers (Bjornsson 2008). Periampullary cancer is the term used for cancers that form near the ampulla of Vater (NCI 2012) and includes cancer of the head and neck of the pancreas, cancer of the distal end of the bile duct, cancer of the ampulla of Vater, and cancer of the second part of the duodenum.…”

Percutaneous Transhepatic Biliary Drainage is Effective in Palliative Management of Malignant Obstructive Jaundice

“…Malignant obstructive jaundice is a common clinical problem and can occur due to variety of causes [4] . Since, the resectability rate of these malignant tumours is lower than 10% [5] , palliative treatment is highly recommended, in view of the shorter life expectancy [6] . Interventional radiologist plays an important role in the management of patients with malignant biliary obstruction.…”

Clinical Impact of Percutaneous Transhepatic Insertion of Metal Biliary Endoprostheses for Palliation of Jaundice and Facilitation of Chemotherapy

“…Malignant biliary obstruction (MBO) carries a 2-year mortality rate of 95%, compared with 22% for benign obstruction. 1 Of those undergoing surgery for MBO, < 38% survive for 1 year. 1 Most often the obstructing lesion is not resectable at the time of diagnosis, and palliative measures must be sought in an attempt to improve the quality of life and survival.…”

“…1 Of those undergoing surgery for MBO, < 38% survive for 1 year. 1 Most often the obstructing lesion is not resectable at the time of diagnosis, and palliative measures must be sought in an attempt to improve the quality of life and survival. 2,3 Clinical indications for biliary drainage include pruritus, which can markedly affect the quality of life and is alleviated by drainage in most cases, [4][5][6][7] and cholangitis, which is itself an important complication of nonoperative instrumentation of the biliary tree.…”

“…Common etiologies for malignant obstruction include pancreatic adenocarcinoma, cholangiocarcinoma, and metastatic disease. 1 The prognosis for this patient population is extremely poor. Malignant biliary obstruction (MBO) carries a 2-year mortality rate of 95%, compared with 22% for benign obstruction.…”