A Study on Endoscopic Palliation of Malignant Biliary Obstruction by Plastic Stents

Shameem Ahmed, M (2010) A Study on Endoscopic Palliation of Malignant Biliary Obstruction by Plastic Stents. Masters thesis, Kilpauk Medical College, Chennai.

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Abstract

INTRODUCTION: Malignant biliary obstruction comprises of malignancies causing proximal malignant obstruction like Gallbladder carcinoma, hilar cholangiocarcinoma, node causing obstruction and malignancies causing distal malignant biliary obstruction including pancreatic malignancy, ampullary adenocarcinoma, distal cholangiocarcinoma and duodenal adenocarcinoma. AIM OF THE STUDY: 1. To Study the causes of Malignant Biliary obstruction 2. To Study the success rate of endoscopic stenting in patients with malignant biliary obstruction. 3. To Study the reason for failure in endoscopic stenting. 4. To Study the morbidity and mortality of endocopic Biliary stenting. 5. To Study the effectiveness of 7F and 10F in endoscopic palliation of jaundice. 6. To Study the difference in patency rates of 7F and 10F plastic stent. 7. To Study the complication rate between 7F and 10F endocopic stenting. MATERIALS AND METHODS: The Study was conducted in Department of Digestive Health and Disease (DDHD) a super speciality department with rich heritage located in Government peripheral hospital, Anna Nagar, Chennai, attached to Government Kilpauk Medical College, Chennai. The study was conducted in DDHD inpatients and patients referred from Government Kilpauk Medical College (Surgical Gastroenterology, General Surgery), Government Royapettah Hospital (Surgical Gastroenterology, General Surgery), Government General Hospital (Surgical Gastroenterology, General Surgery).The study period was from December 2007 to December 2009. Patients with Malignant Biliary obstruction were divided in to two groups 1. Proximal Biliary Obstruction, 2. Distal Biliary Obstruction. After ERCP stenting patients with 7F plastic stent were compared with patients with 10F plastic stents. INCLUSION AND EXCLUSION CRITERIA: 1. All patients with Malignant biliary obstruction with informed consent were included. 2. Candidates not willing were excluded. 3. Candidates not fit for ERCP procedure were excluded. 4. Patients in whom benign cause was suspected were excluded. We used Duodenoscope of length 156cm working channel diameter of 4.2mm, field of view 1100 (Model No.ED341C Batch No.A120052) with a PENTAX video processor EPK 150C input 100-240V-50/60HZ ranging 300 VA max. We used ERBE endocut (Model ICC 200 EA INT) for Biliary sphincterotomy with cutting current 120 effect 3 without coagulation. CONCLUSION: 1. Most common cause of malignant biliary obstruction in this study was ampullary adenocarcinoma followed by distal cholangiocarcinoma, hilar cholangiocarcinoma, head of pancreas malignancy, Gall Bladder carcinoma and lymph node causing hilar obstruction. 2. Over all success rate of all patients with Malignant Biliary Obstruction was 68.6% with success rate of 78% for patients with distal Malignant Biliary Obstruction and 60% for patients with proximal Malignant Biliary Obstruction cases. 3. Most common reason for failure of endoscopic stenting in patients with malignant biliary obstruction was repeated entry of guidewire into pancreatic duct followed by tight stricture, nonvisualization of ampulla, anatomical difficulties and periampullary diverticulum. 4. Immediate complication rate was 10% with no mortality. Cholangitis being the commonest complication followed by pancreatitis, perforation, stent migration in one patient each. 5. Both 7F and 10F were equally effective in reducing jaundice in the short term. 6. Mean number of days of stent patency after 10F stent was 217 days and 61 days after 7F which was statistically significant. 7. Complication rate between patients treated with 7F Plastic stent and 10F plastic stent were similar.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Endoscopic Palliation, Malignant Biliary Obstruction, Plastic Stents.
Subjects: MEDICAL > Gastroenterology
Depositing User: Subramani R
Date Deposited: 07 Mar 2020 02:43
Last Modified: 07 Mar 2020 05:25
URI: http://repository-tnmgrmu.ac.in/id/eprint/12157

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