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Ongen G, Nas OF, Hacikurt K, Dundar HZ, Ozkaya G, Kaya E, Hakyemez B. Internal versus external biliary drainage in malignant biliary obstructions: is there a difference in the rate of infection? Acta Radiol 2023; 64:2501-2505. [PMID: 37611191 DOI: 10.1177/02841851231187078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
BACKGROUND Percutaneous biliary drainage is a frequently used method to provide biliary decompression in patients with biliary obstruction. PURPOSE To investigate the between drainage type and infection risk in patients treated with internal-external and external biliary drainage catheterization for malignant biliary obstruction. MATERIAL AND METHODS A total of 410 patients with malignant biliary obstruction who underwent internal-external or external biliary drainage catheterization between January 2012 and October 2016 were retrospectively evaluated. We investigated the correlation between percutaneous biliary drainage technique and infection frequency by evaluating patients with clinical findings, bile and blood cultures, complete blood counts, and blood biochemistry. RESULTS There was no statistically significant difference between the selected patient groups (internal-external or external biliary drainage catheter placed) in terms of age, sex, primary diagnosis, receiving chemotherapy, catheter sizes, and outpatient-patient status. After catheterization, catheter-related infection was observed in 49 of 216 (22.7%) patients with internal-external and 18 of 127 (14.2%) patients with external biliary drainage catheters, according to the defined criteria. There was no difference in infection rate after the biliary drainage in the two groups (P > 0.05). There was also no difference concerning frequently proliferating microorganisms in bile cultures. CONCLUSION Internal-external biliary drainage catheter placement does not bring an additional infection risk for uninfected cholestatic patients whose obstruction could be passed easily in the initial drainage.
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Affiliation(s)
- Gokhan Ongen
- School of Medicine, Department of Radiology, Bursa Uludag University, Bursa, Turkey
| | - Omer Fatih Nas
- School of Medicine, Department of Radiology, Bursa Uludag University, Bursa, Turkey
| | - Kadir Hacikurt
- Department of Radiology, Eastbourne District General Hospital, East Sussex, England
| | - Halit Ziya Dundar
- Department of General Surgery, Bursa Medicana Hospital, Bursa, Turkey
| | - Guven Ozkaya
- School of Medicine, Department of Biostatistics, Bursa Uludag University, Bursa, Turkey
| | - Ekrem Kaya
- School of Medicine, Department of General Surgery, Bursa Uludag University, Bursa, Turkey
| | - Bahattin Hakyemez
- School of Medicine, Department of Radiology, Bursa Uludag University, Bursa, Turkey
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Kobayashi S, Ueno M, Nagashima S, Sano Y, Kawano K, Fukushima T, Asama H, Tezuka S, Morimoto M. Association between time to stent dysfunction and the anti-tumour effect of systemic chemotherapy following stent placement in patients with pancreaticobiliary cancers and malignant gastric outlet obstruction: a retrospective cohort study. BMC Cancer 2021; 21:576. [PMID: 34011301 PMCID: PMC8136227 DOI: 10.1186/s12885-021-08336-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/10/2021] [Indexed: 12/22/2022] Open
Abstract
Background Malignant gastric outlet obstruction (MGOO) occasionally occurs due to pancreaticobiliary cancer. Endoscopic duodenal stenting (DS) is a common treatment for MGOO. However, it has been reported that DS does not have sufficient patency time for it to be used in patients who have a potentially increased lifespan. Nowadays, systemic chemotherapy for pancreaticobiliary cancer has developed, and its anti-tumour effect would make time to stent dysfunction longer. Therefore, we retrospectively evaluated the association between objective response to systemic chemotherapy, followed by DS and time to stent dysfunction in patients with advanced pancreaticobiliary cancer. Methods This retrospective study included 109 patients with advanced pancreaticobiliary cancer who received systemic chemotherapy after DS. Patients who showed complete or partial response were defined as responders. The rest were defined as non-responders. Time to stent dysfunction was compared between responders and non-responders using the landmark analysis at 2 months after DS. Death without recurrence of MGOO was considered as a competing risk for time to stent dysfunction. Results Combination and monotherapy regimens were adopted for 46 and 63 patients, respectively. Median progression-free survival and overall survival were 3.2 months (95% confidence interval [CI], 2.4–4.0) and 6.0 months (95% CI, 4.6–7.3). Objective response was observed in 21 patients (19.3%). Median time to stent dysfunction was 12.5 months (95% CI, 8.4–16.5) in the entire cohort. In 89 patients, responders had a lower cumulative incidence of stent dysfunction than non-responders: 9.5 and 19.1% at 6 months, and 19.0 and 27.9% at 1-year, respectively. There was difference of time to stent dysfunction between responders and non-responders among patients who received combination regimen as the first-line treatment with p-value of 0.009: cumulative incidence was 0 and 42.9% at 6 months, and 9.3 and 57.1% at 1-year, respectively. Conclusions Longer time to stent dysfunction is expected when systemic chemotherapy following DS suppresses tumour progression; DS is slated to be a standard treatment for MGOO even in patients with pancreaticobiliary cancer and a long lifespan. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08336-z.
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Affiliation(s)
- Satoshi Kobayashi
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama City, 241-0815, Japan.
| | - Makoto Ueno
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama City, 241-0815, Japan
| | - Shuhei Nagashima
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama City, 241-0815, Japan
| | - Yusuke Sano
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama City, 241-0815, Japan
| | - Kuniyuki Kawano
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama City, 241-0815, Japan
| | - Taito Fukushima
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama City, 241-0815, Japan
| | - Hiroyuki Asama
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama City, 241-0815, Japan
| | - Shun Tezuka
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama City, 241-0815, Japan
| | - Manabu Morimoto
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama City, 241-0815, Japan
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Nakai Y, Isayama H, Wang H, Rerknimitr R, Khor C, Yasuda I, Kogure H, Moon JH, Lau J, Lakhtakia S, Ratanachu‐ek T, Seo DW, Lee DK, Makmun D, Dy F, Liao W, Draganov PV, Almadi M, Irisawa A, Katanuma A, Kitano M, Ryozawa S, Fujisawa T, Wallace MB, Itoi T, Devereaux B. International consensus statements for endoscopic management of distal biliary stricture. J Gastroenterol Hepatol 2020; 35:967-979. [PMID: 31802537 PMCID: PMC7318125 DOI: 10.1111/jgh.14955] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 02/05/2023]
Abstract
Distal biliary strictures (DBS) are common and may be caused by both malignant and benign pathologies. While endoscopic procedures play a major role in their management, a comprehensive review of the subject is still lacking. Our consensus statements were formulated by a group of expert Asian pancreatico-biliary interventional endoscopists, following a proposal from the Digestive Endoscopy Society of Taiwan, the Thai Association for Gastrointestinal Endoscopy, and the Tokyo Conference of Asian Pancreato-biliary Interventional Endoscopy. Based on a literature review utilizing Medline, Cochrane library, and Embase databases, a total of 19 consensus statements on DBS were made on diagnosis, endoscopic drainage, benign biliary stricture, malignant biliary stricture, and management of recurrent biliary obstruction and other complications. Our consensus statements provide comprehensive guidance for the endoscopic management of DBS.
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Affiliation(s)
- Yousuke Nakai
- Department of Gastroenterology, Graduate School of MedicineThe University of TokyoTokyoJapan
- Department of Endoscopy and Endoscopic Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of MedicineThe University of TokyoTokyoJapan
- Department of Gastroenterology, Graduate School of MedicineJuntendo UniversityTokyoJapan
| | - Hsiu‐Po Wang
- Department of Internal Medicine, College of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of MedicineChulalongkorn UniversityBangkokThailand
| | - Christopher Khor
- Department of Gastroenterology and HepatologySingapore General Hospital and Duke‐NUS Medical SchoolSingaporeSingapore
| | - Ichiro Yasuda
- Third Department of Internal Medicine, Graduate School of MedicineUniversity of ToyamaToyamaJapan
| | - Hirofumi Kogure
- Department of Gastroenterology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Jong Ho Moon
- Digestive Disease Center and Research Institute, Department of Internal MedicineSoonChunHyang University School of MedicineBucheon/SeoulSouth Korea
| | - James Lau
- Department of Surgery, Endoscopic Center, Prince of Wales HospitalThe Chinese University of Hong KongHong Kong, China
| | | | | | - Dong Wan Seo
- Department of Internal MedicineUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulSouth Korea
| | - Dong Ki Lee
- Department of Internal Medicine, Gangnam Severance HospitalYonsei University College of MedicineSeoulSouth Korea
| | - Dadang Makmun
- Division of Gastroenterology, Department of Internal Medicine, Faculty of MedicineUniversitas Indonesia/Cipto Mangunkusumo National General HospitalJakartaIndonesia
| | - Frederick Dy
- Section of Gastroenterology, Department of Internal Medicine, Faculty of Medicine and SurgeryUniversity of Santo Tomas HospitalManilaPhilippines
| | - Wei‐Chih Liao
- Department of Internal Medicine, College of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Peter V Draganov
- Department of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Majid Almadi
- Division of Gastroenterology, King Khalid University HospitalKing Saud UniversityRiyadhSaudi Arabia
| | - Atsushi Irisawa
- Department of GastroenterologyDokkyo Medical UniversityTochigiJapan
| | - Akio Katanuma
- Center for GastroenterologyTeine‐Keijinkai HospitalSapporoJapan
| | - Masayuki Kitano
- Second Department of Internal MedicineWakayama Medical UniversityWakayamaJapan
| | - Shomei Ryozawa
- Department of GastroenterologySaitama Medical University International Medical CenterSaitamaJapan
| | - Toshio Fujisawa
- Department of Gastroenterology, Graduate School of MedicineJuntendo UniversityTokyoJapan
| | | | - Takao Itoi
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Benedict Devereaux
- University of QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
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Haal S, van Hooft JE, Rauws EAJ, Fockens P, Voermans RP. Stent patency in patients with distal malignant biliary obstruction receiving chemo(radio)therapy. Endosc Int Open 2017; 5:E1035-E1043. [PMID: 29090242 PMCID: PMC5658223 DOI: 10.1055/s-0043-117953] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/04/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Recent literature suggests that chemo(radio)therapy might reduce the patency of plastic stents in patients with malignant biliary obstruction. Whether this might also be valid for other types of stents is unknown. The aim of this study was to determine the influence of chemo(radio)therapy on the patency of fully-covered self-expandable metal stents (FCSEMSs) and plastic stents. PATIENTS AND METHODS We retrospectively reviewed the electronic medical records of patients with distal malignant biliary obstruction who underwent biliary stent placement between April 2001 and July 2015. Primary outcome was duration of stent patency. Secondary outcome was stent patency at 3 and 6 months. We used Kaplan-Meier survival analyses to compare stent patency rates between patients who received chemo(radio)therapy and patients who did not. RESULTS A total of 291 biliary stents (151 metal and 140 plastic) were identified. The median cumulative stent patency of FCSEMSs did not differ between patients receiving chemo(radio)therapy (n = 51) and those (n = 100) who did not ( P = 0.70, log-rank test). The estimated cumulative stent patency of plastic stents was also comparable in 99 patients without and 41 patients with chemo(radio)therapy ( P = 0.73, log-rank test). At 3 and 6 months, FCSEMS patency rates were 87 % and 83 % in patients without chemo(radio)therapy and 96 % and 83 % in patients with therapy, respectively. Plastic patency rates were 69 % and 55 % in patients without and 85 % and 39 % in patients with therapy, respectively. After 1 year, 78 % of the FCSEMSs were still patent in patients without chemo(radio)therapy and 69 % of the FCSEMSs were still patent in patients with therapy. CONCLUSION Our data indicate that chemo(radio)therapy does not reduce the patency of biliary fully-covered metal and plastic stents.
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Affiliation(s)
- Sylke Haal
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,Corresponding author S. Haal, MD Stadionplein 85-11076 CK AmsterdamThe Netherlands+31-20-6917033
| | - Jeanin E. van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik A. J. Rauws
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Rogier P. Voermans
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Lamarca A, Rigby C, McNamara MG, Hubner RA, Valle JW. Impact of biliary stent-related events in patients diagnosed with advanced pancreatobiliary tumours receiving palliative chemotherapy. World J Gastroenterol 2016; 22:6065-6075. [PMID: 27468198 PMCID: PMC4948275 DOI: 10.3748/wjg.v22.i26.6065] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/02/2016] [Accepted: 03/02/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the impact (morbidity/mortality) of biliary stent-related events (SRE) (cholangitis or stent obstruction) in chemotherapy-treated pancreatico-biliary patients.
METHODS: All consecutive patients with advanced pancreatobiliary cancer and a biliary stent in-situ prior to starting palliative chemotherapy were identified retrospectively from local electronic case-note records (Jan 13 to Jan 15). The primary end-point was SRE rate and the time-to-SRE (defined as time from first stenting before chemotherapy to date of SRE). Progression-free survival and overall survival were measured from the time of starting chemotherapy. Kaplan-Meier, Cox and Fine-Gray regression (univariate and multivariable) analyses were employed, as appropriate. For the analysis of time-to-SRE, death was considered as a competing event.
RESULTS: Ninety-six out of 693 screened patients were eligible; 89% had a metal stent (the remainder were plastic). The median time of follow-up was 9.6 mo (range 2.2 to 26.4). Forty-one patients (43%) developed a SRE during follow-up [cholangitis (39%), stent obstruction (29%), both (32%)]. There were no significant differences in baseline characteristics between the SRE group and no-SRE groups. Recorded SRE-consequences were: none (37%), chemotherapy delay (24%), discontinuation (17%) and death (22%). The median time-to-SRE was 4.4 mo (95%CI: 3.6-5.5). Patients with severe comorbidities (P < 0.001) and patients with ≥ 2 baseline stents/biliary procedures [HR = 2.3 (95%CI: 1.2-4.44), P = 0.010] had a shorter time-to-SRE on multivariable analysis. Stage was an independent prognostic factor for overall survival (P = 0.029) in the multivariable analysis adjusted for primary tumour site, performance status and development of SRE (SRE group vs no-SRE group).
CONCLUSION: SREs are common and impact on patient’s morbidity. Our results highlight the need for prospective studies exploring the role of prophylactic strategies to prevent/delay SREs.
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Chu KY, Eccles CL, Brunner TB. Endobiliary Stent Position Changes during External-beam Radiotherapy. J Med Imaging Radiat Sci 2015; 46:57-64. [PMID: 26090069 PMCID: PMC4467517 DOI: 10.1016/j.jmir.2014.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
PURPOSE Endobiliary stents can be used as surrogates for pancreatic localization when using cone-beam computed tomography (CBCT) during external-beam radiotherapy (EBRT). This work reports on interfraction stent position changes during EBRT for locally advanced pancreatic cancer (LAPC). MATERIALS AND METHODS Six patients with endobiliary stents who underwent EBRT for LAPC were assessed. Measurements from the most superior aspect of the stent (sup stent) and the most inferior aspect of the stent (inf stent) to the most inferior, posterior aspect of the L1 vertebra central spinous process were determined from daily treatment CBCTs and compared with those determined from the planning computed tomography (CT) scan. Changes in stent-L1 measurements were interpreted as changes in relative stent position. RESULTS Three patients showed mean interfraction stent position changes of ≥1 cm when treatment measurements were compared with planning measurements. The sup stent for patient A moved to the right (2.66 ± 2.77 cm) and inferiorly (3.0 ± 3.12 cm), and the inf stent moved to the right (1.92 ± 2.02 cm) inferiorly (3.23 ± 3.34 cm) and posteriorly (1.41 ± 1.43 cm). The inf stent for patient B moved superiorly (2.23 ± 0.49 cm) and posteriorly (1.72 ± 0.59 cm). The sup and inf stent for patient F moved inferiorly (0.98 ± 0.35 cm and 1.21 ± 0.38 cm, respectively). The remaining three patients C, D, and E showed interfraction position changes of <1 cm. CONCLUSION Endobiliary stent migration and deformation were observed in a small subset of patients. Further investigation is required before confirming their use as surrogates for LAPC target localization during image-guided EBRT.
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Affiliation(s)
- Kwun-Ye Chu
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom ; Radiotherapy Department, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Cynthia L Eccles
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom ; Radiotherapy Department, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Thomas B Brunner
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom ; Department of Radiation Oncology, University of Freiburg, Freiburg im Breisgau, Germany
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Xu C, Huang XE, Wang SX, Lv PH, Sun L, Wang FA. Comparison of Infection between Internal-External and External Percutaneous Transhepatic Biliary Drainage in Treating Patients with Malignant Obstructive Jaundice. Asian Pac J Cancer Prev 2015; 16:2543-6. [DOI: 10.7314/apjcp.2015.16.6.2543] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Xu C, Lv PH, Huang XE, Sun L, Wang SX, Wang FA. Internal-external percutaneous transhepatic biliary drainage for patients with malignant obstructive jaundice. Asian Pac J Cancer Prev 2014; 15:9391-4. [PMID: 25422230 DOI: 10.7314/apjcp.2014.15.21.9391] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the effect of internal-external percutaneous transhepatic biliary drainage (IEPTBD) for patients with malignant obstructive jaundice. METHODS During the period of January 2008 and July 2013, internal-external drainage was performed in 42 patients with malignant obstructive jaundice. During the procedure, if the guide wire could pass through the occlusion and into the duodenum, IEPTBD was performed. External drainage biliary catheter was placed if the occlusion was not crossed. Newly onset of infection, degree of bilirubin decrease and the survival time of patients were selected as parameters to evaluate the effect of IEPTBD. RESULTS Twenty newly onset of infection were recorded after procedure and new infectious rate was 47.6%. Sixteen patients with infection (3 before, 13 after drainage) were uncontrolled after procedure, 12 of them (3 before, 9 after drainage) died within 1 month. The mean TBIL levels declined from 299.53 umol/L before drainage to 257.62 umol/L after drainage, while uninfected group decline from 274.86 umol/L to 132.34 umol/Lp (P < 0.5). The median survival time for uninfected group was 107 days, and for infection group was 43 days (P < 0.05). CONCLUSIONS The IEPTBD drainage may increase the chance of biliary infection, reduce bile drainage efficiency and decrease the long-term prognosis, and the external drainage is a better choice for patients with malignant obstructive jaundice need to biliary drainage.
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Affiliation(s)
- Chuan Xu
- Department of Interventional Radiology, Subei People's Hospital of Jiangsu Province, Clinical Hospital of Yangzhou University, Yangzhou, China E-mail :
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Xu C, Huang XE, Wang SX, Lv PH, Sun L, Wang FA, Wang LF. Drainage alone or combined with anti-tumor therapy for treatment of obstructive jaundice caused by recurrence and metastasis after primary tumor resection. Asian Pac J Cancer Prev 2014; 15:2681-4. [PMID: 24761884 DOI: 10.7314/apjcp.2014.15.6.2681] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AIM To compare drainage alone or combined with anti-tumor therapy for treatment of obstructive jaundice caused by recurrence and metastasis after primary tumor resection. MATERIALS AND METHODS We collect 42 patients with obstructive jaundice caused by recurrence and metastasis after tumor resection from January 2008 - August 2012, for which percutaneous transhepatic catheter drainage (pTCD)/ percutaneous transhepatic biliary stenting (pTBS) were performed. In 25 patients drainage was combined with anti-tumor treatment, antineoplastic therapy including intra/postprodure local treatment and postoperative systemic chemotherapy, the other 17 undergoing drainage only. We assessed the two kinds of treatment with regard to patient prognosis. RESULTS Both treatments demonstrated good effects in reducing bilirubin levels in the short term and promoting liver function. The time to reobstruction was 125 days in the combined group and 89 days in the drainage only group; the mean survival times were 185 and 128 days, the differences being significant. CONCLUSIONS Interventional drainage in the treatment of the obstructive jaundice caused by recurrence and metastasis after tumor resection can decrease bilirubin level quickly in a short term and promote the liver function recovery. Combined treatment prolongs the survival time and period before reobstruction as compared to drainage only.
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Affiliation(s)
- Chuan Xu
- Department of Interventional Radiology, Subei People Hospital of Jiangsu Province, Clinical Hospital of Yangzhou University, Yangzhou, China E-mail :
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Impact of anticancer treatment on recurrent obstruction in covered metallic stents for malignant biliary obstruction. J Gastroenterol 2013; 48:1293-9. [PMID: 23354624 DOI: 10.1007/s00535-013-0749-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 01/04/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND In patients with unresectable malignant biliary obstruction (MBO), anticancer treatment is often administered. The impact of anticancer treatment on recurrent biliary obstruction in covered self-expandable metallic stents (SEMS) has not been fully elucidated. METHODS Data on 279 patients enrolled in a multicenter prospective cohort study of two different covered SEMS for distal MBO, WATCH study (141 partially covered WallFlex stents and 138 partially covered Wallstents) were retrospectively analyzed. The rates and causes of recurrent biliary obstruction (stent occlusion or migration) were compared between anticancer treatment group (n = 173) and best supportive care alone (BSC) group (n = 106). Cumulative time and prognostic factors for recurrent biliary obstruction were analyzed, using a proportional hazards model with death without recurrent biliary obstruction as a competing risk. RESULTS The overall rate (43 vs. 25%, P = 0.002) and the cumulative incidence (16.1 vs. 8.2, 27.9 vs. 18.9 and 44.1 vs. 26.6% at 3, 6 and 12 months, P = 0.030 by Gray's test) of recurrent biliary obstruction were significantly higher in anticancer treatment group compared with BSC group. The multivariate analysis revealed anticancer treatment [subdistribution hazard ratio (SHR) 1.93, P = 0.007) as well as the use of a partially covered WallFlex stent (SHR 0.65, P = 0.049) as prognostic factors. CONCLUSIONS Anticancer treatment was a risk factor for recurrent biliary obstruction in covered SEMS for distal MBO. The superiority of a partially covered WallFlex stent was again confirmed in this competing risk analysis; UMIN-CTR: UMIN000002293.
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Adams MA, Anderson MA, Myles JD, Khalatbari S, Scheiman JM. Self-expanding metal stents (SEMS) provide superior outcomes compared to plastic stents for pancreatic cancer patients undergoing neoadjuvant therapy. J Gastrointest Oncol 2012. [PMID: 23205306 DOI: 10.3978/j.issn.2078-6891.2011.050] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Neoadjuvant therapy is increasingly utilized for pancreatic cancer patients to decrease tumor burden in anticipation of later surgical resection. However, infectious complications such as life threatening cholangitis may occur for those with biliary obstruction. We hypothesized that placement of metal rather than plastic stents in such patients results in lower rates of stent-related complications, leading to improved clinical outcomes. METHODS Retrospective cohort of pancreatic cancer patients treated by the University of Michigan Multidisciplinary Pancreatic Cancer Destination Program between January 2005 and June 2010. Only patients undergoing neoadjuvant therapy with one or more biliary stents placed for malignant obstruction were studied. Time to stent complication was compared between metal and plastic stents. The complication rate was estimated as the ratio of complications to total stent exposure time and 95% confidence intervals were calculated. RESULTS 52 patients met inclusion criteria. A total of 113 stents were placed in 52 patients (70 plastic, 43 metal). The complication rate was almost 7 times higher with plastic stents, 0.20 (95% CI, 0.14-0.30), than with metal stents, 0.03 (95% CI, 0.01-0.06). Moreover, the rate of hospitalization for stent-related complications was 3-fold higher in the plastic stent group than the metal stent group. The first quartile estimate of time to stent complication was almost 5 times longer for metal than for plastic stents (44 vs. 200 days) (P<0.0001). CONCLUSION Compelling evidence indicates that self-expanding metal, not plastic stents should be used for malignant biliary obstruction in patients undergoing neoadjuvant therapy for pancreatic cancer.
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Affiliation(s)
- Megan A Adams
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System
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Kim JH, Jung ES, Jeong SH, Kim JS, Ku YS, Hahm KB, Kim JH, Kim YS. A case of emphysematous hepatitis with spontaneous pneumoperitoneum in a patient with hilar cholangiocarcinoma. THE KOREAN JOURNAL OF HEPATOLOGY 2012; 18:94-7. [PMID: 22511909 PMCID: PMC3326990 DOI: 10.3350/kjhep.2012.18.1.94] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 08/04/2011] [Accepted: 09/02/2011] [Indexed: 12/14/2022]
Abstract
An 80-year-old woman with hilar cholangiocarcinoma was hospitalized due to sudden-onset abdominal pain. Computed tomography revealed hepatic necrosis accompanied with emphysematous change in the superior segment of the right liver (S7/S8), implying spontaneous rupture, based on the presence of perihepatic free air. Although urgent percutaneous drainage was performed, neither pus nor fluids were drained. These findings suggest emphysematous hepatitis with a hepatic mass. Despite the application of intensive care, the patient's condition deteriorated rapidly, and she died 3 days after admission to hospital. Liver gas has been reported in some clinical diseases (e.g., liver abscess) to be caused by gas-forming organisms; however, emphysematous hepatitis simulating emphysematous pyelonephritis is very rare. The case reported here was of fatal emphysematous hepatitis in a patient with hilar cholangiocarcinoma.
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Affiliation(s)
- Jung Ho Kim
- Department of Internal Medicine, Gachon University Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea
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Nakai Y, Isayama H, Kawabe T, Tsujino T, Yoshida H, Sasaki T, Tada M, Arizumi T, Yagioka H, Kogure H, Togawa O, Ito Y, Matsubara S, Hirano K, Sasahira N, Omata M. Efficacy and safety of metallic stents in patients with unresectable pancreatic cancer receiving gemcitabine. Pancreas 2008; 37:405-410. [PMID: 18953253 DOI: 10.1097/mpa.0b013e3181706d93] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Expandable metallic stents (EMSs) are widely used to palliate unresectable malignant biliary obstructions. The efficacy and safety of EMS in patients receiving gemcitabine (GEM) for unresectable pancreatic cancer is evaluated. METHODS Data for 147 patients with unresectable pancreatic cancer were studied retrospectively: 52 received GEM without EMS, 36 received GEM with EMS, 27 received only best supportive care (BSC) without EMS, and 32 received BSC with EMS. RESULTS Expandable metallic stent did not increase adverse effects (>grade 2) caused by GEM (P = 0.809), and the rates of infections other than cholangitis and cholecystitis were neither increased by GEM nor by EMS (P = 0.287). Cholangitis and cholecystitis occurred exclusively in patients with EMS and was managed successfully. Tumor extension, good performance status, and GEM, but not EMS, were shown to affect survival. Stent-related complications were observed in 26 patients (72%) receiving GEM and in 17 patients (53%) with BSC (P = 0.133). Multivariate analyses revealed no predictors for stent-related complications, although the use of covered EMS and good performance status were associated with longer stent patency. Gemcitabine affected neither stent-related complications nor stent patency. CONCLUSIONS Expandable metallic stent placement is safe and effective in patients with unresectable pancreatic cancer receiving GEM. Gemcitabine improves survival irrespective of EMS placement.
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Affiliation(s)
- Yousuke Nakai
- Department of Gastroenterology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
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Grimison PS, Chin MT, Harrison ML, Goldstein D. Primary pancreatic lymphoma--pancreatic tumours that are potentially curable without resection, a retrospective review of four cases. BMC Cancer 2006; 6:117. [PMID: 16674812 PMCID: PMC1475874 DOI: 10.1186/1471-2407-6-117] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Accepted: 05/04/2006] [Indexed: 12/11/2022] Open
Abstract
Background Primary pancreatic lymphomas (PPL) are rare tumours of the pancreas. Symptoms, imaging and tumour markers can mimic pancreatic adenocarcinoma, but they are much more amenable to treatment. Treatment for PPL remains controversial, particularly the role of surgical resection. Methods Four cases of primary pancreatic lymphoma were identified at Prince of Wales Hospital, Sydney, Australia. A literature review of cases of PPL reported between 1985 and 2005 was conducted, and outcomes were contrasted. Results All four patients presented with upper abdominal symptoms associated with weight loss. One case was diagnosed without surgery. No patients underwent pancreatectomy. All patients were treated with chemotherapy and radiotherapy, and two of four patients received rituximab. One patient died at 32 months. Three patients are disease free at 15, 25 and 64 months, one after successful retreatment. Literature review identified a further 103 patients in 11 case series. Outcomes in our series and other series of chemotherapy and radiotherapy compared favourably to surgical series. Conclusion Biopsy of all pancreatic masses is essential, to exclude potentially curable conditions such as PPL, and can be performed without laparotomy. Combined multimodality treatment, utilising chemotherapy and radiotherapy, without surgical resection is advocated but a cooperative prospective study would lead to further improvement in treatment outcomes.
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Affiliation(s)
- Peter S Grimison
- Institute of Oncology, Prince of Wales Hospital, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Melvin T Chin
- Institute of Oncology, Prince of Wales Hospital, Sydney, Australia
| | | | - David Goldstein
- Institute of Oncology, Prince of Wales Hospital, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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Van Laethem JL, De Broux S, Eisendrath P, Cremer M, Le Moine O, Devière J. Clinical impact of biliary drainage and jaundice resolution in patients with obstructive metastases at the hilum. Am J Gastroenterol 2003; 98:1271-7. [PMID: 12818268 DOI: 10.1111/j.1572-0241.2003.07504.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES For patients presenting with progressive liver or lymph node metastases (LM) causing obstructive jaundice, survival without adequate biliary drainage is very brief. The aim of this study was to assess the impact of endoscopic drainage for biliary obstruction secondary to LM at the hilum on subsequent administration of chemotherapy and on patient outcome. METHODS Thirty-five patients were studied and underwent insertion of plastic and/or metal stents, endoscopically (80%) or percutaneously and endoscopically (20%), to obtain complete resolution of jaundice. LM originated from colon (n = 16), gastric (n = 5), breast (n = 5), pancreatic (n = 3), and miscellaneous cancers (n = 6). Bile duct strictures were Bismuth type I-II in 13 patients and type III in 22. RESULTS The overall rate of success (i.e., complete resolution of jaundice) was 86% after a median of three procedures per patient (range, 1-7). Pruritus, jaundice, nausea, abdominal pain, and anorexia improved significantly in 88, 86, 75, 66, and 50% of cases, respectively. Overall median survival was 4 months and was 6.5 versus 1.8 months (p < 0.05) in the groups of patients whose jaundice resolved completely versus incompletely. The type of stricture did not affect survival. Patients with colon and breast cancer who were eligible for second line chemotherapy after optimal drainage had the longest survival (12-16 months). CONCLUSIONS In our patients with obstructive LM, endoscopic biliary drainage completely resolved jaundice in 86% and improved clinical symptoms and survival, thus enabling these patients to have additional chemotherapy.
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