Biliary Decompression in Malignant Obstructive Jaundice
https://doi.org/10.16931/1995-5464.2015354-58
Abstract
Aim. Determination of optimal method and study of results of minimally invasive biliary decompression in neoplastic obstructive jaundice.
Materials and Methods. Biliary decompression was performed in 59 patients who were divided into groups of percutaneous drainage (n = 33) and transpapillary stenting (n = 26). In the second stage priority tactic of transpapillary biliary decompression was used in the prospective group of patients (n = 159).
Results. Transpapillary and/or percutaneous biliary drainage was performed in all patients. There was high efficiency of cholestasis syndrome relief (serum bilirubin levels decreased by 39.2%, 53.9% and 77.0% at 3, 7 and 14 day after surgery respectively). Lower incidence of complications was revealed in patients after transpapillary decompression (n = 2; 7.7%) compared with percutaneous technique (n = 10; 30.3%, p = 0.032). Herewith clinical effectiveness and mortality were similar (p = 0.316). In the prospective group of 159 patients transpapillary stenting (n = 107; 63%) was ineffective in 31 case (29.9%), that required additional endoscopic treatment (n = 12) or percutaneous biliary drainage (n = 19). Mortality rate was 13.8% (22 patients).
Conclusion. Endoscopic transpapillary stenting can be recommended in malignant obstructive jaundice management because of low incidence of complications and equal effectiveness and mortality. Percutaneous biliary drainage with primary or delayed recanalization of malignant stricture should be done if transpapillary stenting is impossible due to technical or anatomical aspects. The algorithm provides differentiated approach to choice of biliary decompression
method and improves treatment outcomes.
About the Authors
A. V. Tarabukin
Chair of Surgery of Northern State Medical University, Ministry of Health of the Russian Federation; Е.Е. Volosevich First City Clinical Hospital
Russian Federation
Head of the Third Surgical Department, E.Е. Volosevich First City Clinical Hospital
Russian Federation
Head of the Third Surgical Department, E.Е. Volosevich First City Clinical Hospital
D. V. Mizgirev
Chair of Surgery of Northern State Medical University, Ministry of Health of the Russian Federation; Е.Е. Volosevich First City Clinical Hospital
Russian Federation
Russian Federation
Cand. of Med. Sci., Associate Professor of Chair of Surgery of Northern State Medical University, Surgeon of the Second Unit of the Department of Endovascular Diagnosis and Treatment, Е.Е. Volosevich First City Clinical Hospital
A. M. Epshtein
Chair of Surgery of Northern State Medical University, Ministry of Health of the Russian Federation; Е.Е. Volosevich First City Clinical Hospital
Russian Federation
Russian Federation
Cand. of Med. Sci., Endoscopist of the Second Unit of the Department of Endovascular Diagnosis and Treatment, Е.Е. Volosevich First City Clinical Hospital, Assistant of Chair of Surgery, Northern State Medical University.
V. N. Pozdeev
Chair of Surgery of Northern State Medical University, Ministry of Health of the Russian Federation; Е.Е. Volosevich First City Clinical Hospital
Russian Federation
Russian Federation
Cand. of Med. Sci., Deputy Chief Physician of Е.Е. Volosevich First City Clinical Hospital, Assistant of Chair of Surgery, Northern State Medical University
S. S. Pozdeev
Е.Е. Volosevich First City Clinical Hospital
Russian Federation
Russian Federation
Endoscopist of the Second Unit of the Department of Endovascular Diagnosis and Treatment, Е.Е. Volosevich First City Clinical Hospital
B. L. Duberman
Chair of Surgery of Northern State Medical University, Ministry of Health of the Russian Federation; Е.Е. Volosevich First City Clinical Hospital
Russian Federation
Russian Federation
Doct. of Med. Sci., Head of Chair of Surgery of Northern State Medical University, Head of the Second Unit of the Department of Endovascular Diagnosis and Treatment, Е.Е. Volosevich First City Clinical Hospital
References
1. Руководство по хирургии желчных путей; Под ред. Гальперина Э.И., Ветшева П.С. 2-е изд. М.: Видар-М, 2009. 568 с.
2. Козлов А.В., Таразов П.Г., Гранов Д.А., Поликарпов А.А., Полысалов В.Н., Розенгаус Е.В., Полищук Е.В. Эффективность рентгенэндоваскулярных методов лечения у больных нерезектабельным раком печени и желчных протоков, осложненным механической желтухой. Анналы хирургической гепатологии. 2013; 18 (4): 45–52.
3. Коков Л.С., Черная Н.Р., Кулезнева Ю.В. Лучевая диагностика и малоинвазивное лечение механической желтухи (руководство). М.: Радиология-пресс, 2010. 288 с.
4. Zhang Y.G., Li T.W., Peng W.J., Li G.D., He X.H., Xu L.C. Clinical outcomes and prediction of survival following percutaneous biliary drainage for malignant obstructive jaundice. Oncology Letters. 2014; 7 (4): 1185–1190.
5. Ветшев П.С., Стойко Ю.М., Левчук А.Л., Бардаков В.Г. Возможности современных методов диагностики и обоснование лечебной тактики при механической желтухе. Вестник хирургической гастроэнтерологии. 2008; 2: 24–32.
6. Ившин В.Г., Лукичев О.Д. Малоинвазивные методы декомпрессии желчных путей у больных механической желтухой (оснащение и техника выполнения). Тула: Гриф и К, 2003. 182 с.
7. Hatzaras I., George N., Muscarella P., Melvin W.S., Ellison E.C., Bloomston M. Predictors of survival in periampullary cancers following pancreaticoduodenectomy. Ann. Surg. Oncol. 2010; 17 (4): 991–997. doi: 10.1245/s10434-009-0883-9.
8. Iacono C., Ruzzenente A., Campagnaro T., Bortolasi L., Valdegamberi A., Guglielmi A. Role of preoperative biliary drainage in jaundiced patients who are candidates for pancreatoduodenectomy or hepatic resection: highlights and drawbacks. Ann. Surg. 201; 257 (2): 191–204. doi: 10.1097/SLA.0b013e31826f4b0e.
9. Henson D.E., Schwartz A.M., Nsouli H., Albores-Saavedra J. Carcinomas of the pancreas, gallbladder, extrahepatic bile ducts, and ampulla of vater share a field for carcinogenesis: a populationbased study. Arch. Pathol. Lab. Med. 2009; 133 (1): 67–71. doi: 10.1043/1543-2165-133.1.67.
10. Clavien P.A., Barkun J., de Oliveira M.L., Vauthey J.N., Dindo D., Schulick R.D., de Santibanes E., Pekolj J., Slankamenac K., Bassi C., Graf R., Vonlanthen R., Padbury R., Cameron J.L., Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann. Surg. 2009; 250 (2): 187–196. doi: 10.1097/SLA.0b013e3181b13ca2.
11. Dindo D., Demartines N., Clavien P.A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann. Surg. 2004; 240 (2): 205–213.
Review
For citations:
Tarabukin A.V., Mizgirev D.V., Epshtein A.M., Pozdeev V.N., Pozdeev S.S., Duberman B.L. Biliary Decompression in Malignant Obstructive Jaundice. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2015;20(3):54-58. (In Russ.) https://doi.org/10.16931/1995-5464.2015354-58
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