Percutaneous transhepatic biliary drainage and stenting for malignant obstructive jaundice: A report of two cases

Abstract

Abstract. Malignant obstructive jaundice comprises a group of diseases that can be caused by primary biliary and extra-biliary carcinomas. Generally, surgical resection is the primary treatment for malignant obstructive jaundice; however, for the patients that are unable to undergo surgery, urgent treatment is required to improve hepatic function. Percutaneous transhepatic biliary drainage (PTBD) and stenting are emerging alternative treatments for malignant obstructive jaundice. PTBD and stenting have exhibited good efficacy for the treatment of malignant obstructive jaundice, with few complications and reduced associated pain. IntroductionMalignant obstructive jaundice comprises a group of diseases that can be caused by primary biliary carcinomas, such as cholangiocarcinoma and gallbladder cancer, and extra-biliary carcinomas, such as ampullary, pancreatic and gastric cancer and hepatocellular carcinoma (1). Malignant obstructive jaundice can lead to hyperbilirubinemia, anorexia, pruritus, cholangitis, septicemia and liver failure. Generally, surgical resection remains the primary treatment for malignant obstructive jaundice; however, in numerous cases the malignant obstructive jaundice is detected when the disease is already at an advanced stage (2). For the patients that are unable to undergo surgery, urgent treatment is required to improve hepatic function, in order to facilitate the addition of subsequent anti-tumor therapy to their treatment regimen. The average survival time of patients with obstructive jaundice is <3 months (3). Percutaneous transhepatic biliary drainage (PTBD) and stenting are emerging alternative treatments for malignant obstructive jaundice that exhibit good clinical efficacy and few complications and lead to limited patient suffering. PTBD and stenting is the first choice for elderly patients, patients with inoperable malignant obstructive jaundice, and patients with postoperative recurrence, diabetes, or cardiovascular disease. Case reportCase 1. The patient was a 51-year-old man who presented with ~3 weeks' history of obstructive jaundice. The patient was admitted to Fuyan People's Hospital (Fuyang, China) on June 12, 2014. Liver and kidney function analyses, and routine blood tests were conducted upon admission; and heaptic bilirubin levels were higher than normal. Abdominal computed tomography (CT) showed pancreatic cancer, as well as dilation of the intra-and extrahepatic bile ducts. The patient was at an advanced disease stage and refused to undergo surgical resection. PTBD and stenting were performed in the interventional operating room following the provision of informed consent by the patient. The procedure to puncture the biliary duct was guided under ultrasound (US). An 18-G Chiba needle and a 0.035-inch guide-wire were used to gain access to the biliary system using a right-sided puncture approach. An 8-F sheath was inserted to facilitate the procedure. A 0.035-inch hydrophilic guide-wire was advanced through the stenosis into the duodenum. The hydrophilic guide-wire was...

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

“…The mean fall in S.G.P.T levels was 4.9 IU/L in our study while it was 35 IU/L for Shao et al [11] . This low level of fall in our study may be due to the value measured at different times following intervention which was at day 1 in our case & at 1 month in case of Shao et al [11] . Nevertheless, the fall in S.G.P.T levels were not statistically significant (p value 0.204).…”

“…The mean serum bilirubin value fell to 76% of its original value on 1st post procedure day in our study. Mean fall in serum bilirubin was 4.1 mg% on day 1 and the mean fall in serum bilirubin was 227 µmol/l (13.7 mg% after correction) at 1 month follow up [10,11] . The fall in bilirubin in our study noted on 1 st post procedure day was statistically significant also (p value < 0.001 ).…”

Clinical efficacy of laparoscopic modified loop cholecystojejunostomy for the treatment of malignant obstructive jaundice

“…These two approaches are prone to stent blockage, stent displacement, postoperative cholangitis, biliary infection, and other complications. 5 , 8 , 9 …”

“…These two approaches are prone to stent blockage, stent displacement, postoperative cholangitis, biliary infection, and other complications. 5,8,9 Biliojejunostomy is the main surgical shunt technique and is widely used for patients with malignant obstructive jaundice. Traditional Roux-en-Y anastomosis requires surgical resection of the gallbladder and common bile duct with bile duct end-toside anastomosis followed by side-to-side enteroenterostomy.…”

Assessment of treatment outcomes in patients with advanced hilar cholangiocarcinoma (stages III–IV)

“…The most appropriate liver segments for drainage was selected, and after that, a metallic stent was inserted alongside the guidewire into the segment. [ 8 , 12 ] After surgery or interventional therapy, patients were monitored closely for their vital signs, liver and kidney functions, and oxygen saturation. Abnormal enlargement of abdomen and wound infection was also under surveillance.…”