scholarly journals White bile in patients with malignant biliary obstruction is an independent factor of poor survival

2021 ◽  
Vol 09 (02) ◽  
pp. E203-E209
Author(s):  
Rosario Dʼalmeida ◽  
Coralie Barbe ◽  
Valérie Untereiner ◽  
Fidy Ramaholimihaso ◽  
Pascal Renard ◽  
...  
Keyword(s):  
Bile Duct ◽  
Bilirubin Level ◽  
Biliary Obstruction ◽  
Malignant Biliary Obstruction ◽  
Stent Insertion ◽  
Serum Total Bilirubin ◽  
Independent Factor ◽  
Poor Survival ◽  
Malignant Obstructive Jaundice ◽  
White Bile

Abstract Background and study aims White bile is defined as a colorless fluid occasionally found in the biliary tract of patients with bile duct obstruction. Its significance is not clearly established. Our objective was to analyze the prognostic value of white bile in a series of patients with biliary obstruction due to biliary or pancreatic cancer. Patients and methods The study was conducted on a series of consecutive patients with malignant obstructive jaundice. They all underwent endoscopic retrograde cholangiopancreatography with collection of bile and biliary stent insertion. White bile was defined as bile duct fluid with bilirubin level < 20 µmol/L. Univariate and multivariate analyses were performed to identify variables associated with overall survival (OS). Results Seventy-three patients were included (32 pancreatic cancers, 41 bile duct cancers). Thirty-nine (53.4 %) had white bile. The mean bile duct bilirubin level in this group was 4.2 ± 5.9 µmol/L vs 991 ± 1039 µmol/L in patients with colored bile (P < 0.0001). In the group of 54 patients not eligible for surgery, the multivariate analysis demonstrated an association between the presence of white bile and reduced OS (HR 2.3, 95 %CI 1.1–4.7; P = 0.02). Other factors independently associated with OS were metastatic extension (HR 2.8, 95 %CI 1.4–5.7) and serum total bilirubin (HR 1.003, 95 %CI 1.001–1.006). There was a significant inverse correlation between serum and bile duct bilirubin levels (r = –0.43, P = 0.0001). Conclusion White bile in patients with inoperable malignant biliary obstruction is an independent factor of poor survival.

Fractures of self-expanding metallic stents in periampullary malignant biliary obstruction

2009 ◽  
Vol 50 (7) ◽  
pp. 730-737 ◽  
Author(s):  
I. C. Rasmussen ◽  
U. Dahlstrand ◽  
G. Sandblom ◽  
L. G. Eriksson ◽  
R. Nyman
Keyword(s):  
Biliary Obstruction ◽  
Malignant Biliary Obstruction ◽  
Metallic Stents ◽  
Biliary Duct ◽  
Stent Insertion ◽  
Stent Fracture ◽  
Metallic Stent ◽  
Stent Patency ◽  
Life Threatening ◽  
The Mean

Background: Self-expanding metallic stents are widely used for relieving biliary duct obstruction in patients with unresectable periampullary malignancies. However, only a few studies have assessed the occurrence of fractures in these stents. Purpose: To determine the prevalence and significance of stent fracture after placement of self-expanding metallic stents for periampullary malignant biliary obstruction. Material and Methods: Over a 5-year period, 48 patients underwent placement of self-expanding metallic stents for periampullary malignant biliary obstructions. Stents were introduced 2–6 weeks after a percutaneous transhepatic biliary decompression. The medical records and relevant images were reviewed for stent patency, stent fracture, type of stent, and stent-related complications. Results: Stent fracture was detected in four of the 48 patients (8%): in one patient at 1 month and in three patients between 10 and 21 months after stenting. All four fractures involved one type of nitinol stent used in 38 patients. In one of the patients, fracture was complicated by life-threatening gastrointestinal bleeding. The mean survival time for all patients was 251 days (standard deviation [SD]±275 days) and the mean overall patency time for all stents was 187 days (SD±205 days). Conclusion: Stent fracture occurs after placement of self-expanding nitinol stents for periampullary malignant biliary obstruction. The low reported incidence of this complication may be due to a lack of awareness of and difficulty in detecting stent fracture. Fracture should be considered as a possible contributing factor in recurrent biliary obstruction after self-expanding metallic stent insertion.

scholarly journals Metastatic melanoma presenting as malignant biliary obstruction of the common bile duct demonstrated with single-operator digital cholangioscopy

VideoGIE ◽  
2017 ◽  
Vol 2 (10) ◽  
pp. 266-267
Author(s):  
Prapimphan Aumpansub ◽  
Phonthep Angsuwatcharakon ◽  
Naruemon Wisedopas ◽  
Wiriyaporn Ridtitid ◽  
Rungsun Rerknimitr
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Metastatic Melanoma ◽  
Biliary Obstruction ◽  
Malignant Biliary Obstruction ◽  
Single Operator ◽  
The Common

scholarly journals A randomized trial comparing winged versus conventional plastic stents for malignant bile duct strictures

2017 ◽  
Vol 05 (07) ◽  
pp. E635-E641 ◽  
Author(s):  
Lachlan Ayres ◽  
Danny Cheriyan ◽  
Ryan Scott ◽  
Edward Kim ◽  
Terry Lee ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Biliary Obstruction ◽  
Malignant Biliary Obstruction ◽  
Conventional Group ◽  
Plastic Stents ◽  
Stent Insertion ◽  
Endoscopic Retrograde ◽  
Stent Patency ◽  
Plastic Stent ◽  
Blinded Trial

Abstract Background and study aims Stent insertion at endoscopic retrograde cholangiopancreatography (ERCP) is an established therapy for managing malignant biliary obstruction. Conventional plastic stents with a tubular design are most commonly used despite limited patency. Plastic stents with a winged design may theoretically increase the duration of stent patency. The aim of this study was to compare stent patency of the winged versus conventional plastic stents in patients with malignant biliary obstruction. Patients and methods A prospective, randomized subject-blinded trial was conducted. Patients with malignant biliary obstruction were randomized (1:1) to either a 10 French winged stent or 7 or 10 French conventional plastic stent. Strictures greater than 1 cm distal to the hilum were included. Patients were followed clinically to determine the frequency of stent failure until surgery, death or study closure. Results Fifty-eight patients were enrolled. Following 9 exclusions, 49 patients were randomized to a winged (n = 23) or conventional stent (n = 26). Median time to stent failure was 89 (95 % CI 26-NA) vs 143 (95 % CI 33 – 266) days (P = 0.963) for the winged and conventional group, respectively. Stent failure for the winged group occurred in 11 (48 %) compared to 14 (54 %) in the conventional group. Median survival was 123 (95 % CI 81 – 189) vs 342 days (95 % CI 123 – 704) (p = 0.084) in the winged and conventional group respectively. There were no procedure related adverse events. Conclusions Improvement in stent patency was not seen with the winged stent when compared to the conventional plastic stent. Clinical trials number NCT01514214.

Presence of white bile in malignant biliary obstruction is associated with poor prognosis: personal preliminary observations

2006 ◽  
Vol 392 (1) ◽  
pp. 61-65 ◽  
Author(s):  
Girolamo Geraci ◽  
Carmelo Sciumè ◽  
Franco Pisello ◽  
Francesco Li Volsi ◽  
Tiziana Facella ◽  
...  
Keyword(s):  
Biliary Obstruction ◽  
Poor Prognosis ◽  
Malignant Biliary Obstruction ◽  
White Bile

scholarly journals Flushable Exo-Endodrainage: A Modified Palliative Approach to Non-Resectable Malignant Biliary Obstruction

HPB Surgery ◽  
1993 ◽  
Vol 7 (1) ◽  
pp. 25-32
Author(s):  
M. Stierer ◽  
H. Wasl ◽  
H. R. Rosen ◽  
A. P. Marczell ◽  
H. Spoula
Keyword(s):  
Bile Duct ◽  
Biliary Obstruction ◽  
Extrahepatic Bile Duct ◽  
Imaging Techniques ◽  
Necrotizing Pancreatitis ◽  
Malignant Biliary Obstruction ◽  
Palliative Resection ◽  
The Other ◽  
High Complication Rate ◽  
Acute Necrotizing

The introduction of new imaging techniques has markedly improved the diagnosis of hepatobiliary disorders. Due to their anatomic situation, a substantial percentage of malignancies located near the hilus is not suitable for surgical management. We discuss an effective palliative intervention to relieve jaundice. In many instances drainage is a superior choice when biliodigestive anastomoses are not technically feasible and palliative resection carries a high complication rate.We present an irrigatable exo-endodrainage method employing a modified port-a-cath system as a new alternative. In four patients, all older than 75 years, this system was implanted because of jaundice due to unresectable malignant stenosis of the extrahepatic bile duct. One patient (80 years old) died of pre-existing acute necrotizing pancreatitis, although hyperbilirubinemia was found to decrease on the 7th postoperative day. The other three patients showed complete normalization of their bilirubin levels and their port-a-cath systems remained open until their death (at 3 weeks, 6 months and 7 months respectively).

Effect of limited endoscopic sphincterotomy before self-expandable metal stent insertion for malignant biliary obstruction

Pancreatology ◽  
2017 ◽  
Vol 17 (4) ◽  
pp. S12
Author(s):  
Dae Hwan Kang ◽  
Il Eok Jo ◽  
Hyeong Seok Nam ◽  
Hyung Wook Kim ◽  
Su Jin Kim ◽  
...  
Keyword(s):  
Endoscopic Sphincterotomy ◽  
Biliary Obstruction ◽  
Malignant Biliary Obstruction ◽  
Stent Insertion ◽  
Metal Stent ◽  
Self Expandable Metal Stent

scholarly journals Intrahepatic segmental bile duct B3 cholangiojejunostomy in the palliative management of high unresectable malignant biliary obstruction

2004 ◽  
Vol 51 (3) ◽  
pp. 85-91 ◽  
Author(s):  
Aleksandar Karamarkovic ◽  
Natasa Milic ◽  
Vladimir Djukic ◽  
Dejan Radenkovic ◽  
Vasilije Jeremic ◽  
...  
Keyword(s):  
Bile Duct ◽  
Gallbladder Cancer ◽  
Median Survival ◽  
Biliary Obstruction ◽  
Hepatic Duct ◽  
Postoperative Bleeding ◽  
Palliative Therapy ◽  
Rank Test ◽  
Common Hepatic Duct ◽  
Malignant Obstructive Jaundice

Palliating the effects of biliary obstruction is a major goal of therapy in patients with unresectable cancer at the hepatic duct confluence. We reviewed our expirience with intrahepatic holangioenteric bypass to the segmental bile duct B3 as a palliative therapy in patients with unresectable malignant diseases involving the ductal confluence or the common hepatic duct. Since March 2001, we have performed intrahepatic segmental bile duct B3 cholangiojejunostomy by Roux-en-Y fashion utilizing a round ligament approach in 13 patients with malignant obstructive jaundice due to unresectable hilar holangiocarcinoma (8 cases) and gallbladder cancer (5 cases). Mean hospital stay was123 days and mean blood loss was 25060 mL. Postoperative complications occurred in 3 patients (23 %), but there was no surgical complications such as postoperative bleeding, bile leakage or abscess formation. 30-day mortality was 7.7% (1 patient). Late complications (37.5 %) were observed in 3 of the 8 patients who survived for more than 5 months after the surgery. Median survival after B3 cholangiojejunostomy was 9 months (range, 10 days-22 months). Median survival time was significantly greater in patients with hilar cholangio-carcinoma (11.8 months; range: 2-22 months) compared with those with gallbladder cancer (4.6 months; range: 10 days-11.5 months) ( P-0.032 log rank test; P-0.049 Tarone-Ware test). Intrahepatic B3 cholangiojejunostomy when combined with careful patient selection, can provide useful palliation from jaundice, pruritus and cholangitis with acceptable mortality and morbidity rates.

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