Palliative treatment of obstructive jaundice by transpapillary introduction of large bore bile duct endoprosthesis.

Huibregtse, K.; Tytgat, G. N. J.

doi:10.1136/gut.23.5.371

Cited by 174 publications

(60 citation statements)

References 11 publications

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“…Endoprostheses can be placed across strictures, but stent occlusion and cholangitis are frequent, and prospective studies failed to show their benefit. [131][132][133][134][135] Endoscopic dilation of dominant strictures is currently widely practiced despite the lack of prospective randomized controlled trials demonstrating its benefit. 136,137 Retrospective analyses using the Mayo Risk Score to model outcome, however, have suggested that endoscopic dilatation of dominant strictures does improve survival.…”

Section: Dr Marshall Kaplan (Tufts-new England Medicalmentioning

confidence: 99%

Primary sclerosing cholangitis: Summary of a workshop

et al. 2006

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Primary sclerosing cholangitis (PSC) is a rare but important liver disease that leads to cirrhosis and need for liver transplantation in a high proportion of cases. The disease occurs in approximately 1 per 100,000 population per year, usually presents in adulthood, and affects men more often than women. Typical serum biochemical results, autoantibodies and liver biopsy are suggestive but not diagnostic of PSC, the diagnosis requiring cholangiographic demonstration of stricturing and dilatation of the intra-and/or extra-hepatic bile ducts. The natural history of PSC is variable, the average survival being 12 to 17 years. The cause of PSC is still unknown. Although considered an autoimmune disease, PSC has several atypical features and a strong genetic component. The therapy of PSC is unsatisfactory. Standard doses of ursodeoxycholic acid (UDCA) lead to improvements in biochemical abnormalities but not in histology, cholangiographic appearance or survival. Several innovative therapies have been tried in PSC, but with scant evidence of benefit. For patients with high grade strictures, endoscopic dilatation is beneficial. Liver transplantation is successful for end-stage liver disease due to PSC and improves survival. PSC may recur after transplantation but is rarely progressive. The most dreaded complication of PSC is cholangiocarcinoma. Diagnosis of this highly malignant tumor is difficult, and there are no biomarkers for its early detection. Liver transplantation for cholangiocarcinoma has an exceedingly poor outcome, although transplantation with neoadjuvant chemoirradiation holds promise in selected patients. Thus, significant opportunities remain for basic and clinical research into the cause, natural history, and therapy of PSC. 44:746-764.)

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Section: Dr Marshall Kaplan (Tufts-new England Medicalmentioning

confidence: 99%

Primary sclerosing cholangitis: Summary of a workshop

et al. 2006

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“…However, the 1982 [2] development of duodenoscopes with 4.2-mm working channels allowed the use of large-bore (10-11.5-French) plastic stents. Ten-French stents are now the standard caliber, because use of 11.5-Fr plastic stents is more technically challenging and does not increase stent patency [3].…”

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confidence: 99%

Short-term stenting using fully covered self-expandable metal stents for treatment of refractory biliary leaks, postsphincterotomy bleeding, and perforations

Canena

Liberato²,

Horta

et al. 2012

Surg Endosc

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Background Fully covered self-expandable metal stents (FCSEMS) have been used as a rescue therapy for several benign biliary tract conditions (BBC). Long-term stent placement commonly occurs, and prolonged FCSEMS placement is associated with the majority of the complications reported. This study evaluated the duration of stenting and the efficacy and safety of temporary FCSEMS placement for three BBCs: refractory biliary leaks, postsphincterotomy bleeding, and perforations. Methods This was a retrospective case series with longterm follow-up of 25 patients who underwent FCSEMS placement for BBCs. This study included 17 patients with postcholecystectomy refractory biliary leaks who had previously undergone unsuccessful sphincterotomy and plastic stent placement, 4 patients with difficult-to-control postsphincterotomy bleeding, and 4 patients with a perforation following endoscopic sphincterotomy. Stents were removed according to clinical evidence of problem resolution. The review included stenting duration, safe FCSEMS removal, clinical efficacy, complications, and long-term outcomes. During the follow-up period, ERCP and cholangioscopy procedures were performed to exclude the possibility of bile duct lesion development. Results Complete resolution of the initial condition was achieved in all patients. Patients with biliary leaks had a median stent duration time of 16 days (range 7-28 days). Patients with bleeding had stents removed after a median time of 6 days (range 3-15 days). Patients with perforations had their stents removed after a median time of 29.5 days (range 21-30 days). There were no complications related to stenting. Conclusions Temporary placement of a FCSEMS for 30 days or less is an effective rescue therapy for refractory biliary leaks, difficult-to-control post-endoscopic sphincterotomy bleeding, and perforations. Duration of stenting should be different for each type of condition. Stents can be safely removed, and short-term stenting is associated with the absence of early and late complications.

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“…It is presently considered the treatment of choice for unresectable malignant hepatobiliary tract obstructions and the minimally invasive treatment of strictures of the biliary duct. However, late stent occlusion, the major complication with biliary stents, occurs in a significant number of cases (10% to 30%) 2 and is associated with recurrent jaundice, with or without cholangitis. Thus, stent removal and replacement with a new one is often needed incurring additional health care costs and worsening the patient's quality of life.…”

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confidence: 99%