Validity of MDCT cholangiography in differentiating benign and malignant biliary obstruction

Background MDCT cholangiography can be utilized to identify variant biliary anatomy to guide preoperative planning of biliary surgery, and determine the cause and level of biliary obstruction. Early tumor detection and staging of biliary cancer are key factors for a possible cure by surgical resection. Between December 2019 and October 2020, 69 patients with clinically suspected biliary obstruction were enrolled in the study, subjected to clinical assessment (full history taking and clinical examination) and imaging assessment by MDCT cholangiography. Our findings were correlated to standard reference examinations including operative/ERCP/biopsy and histopathology findings. Results The most affected age was between 60 and 70 years old, and males were more affected. The commonest clinical presentation was yellowish discoloration of the skin and sclera followed by biliary colic. Right hypochondrial tenderness was the main clinical finding on clinical examination. Our patients were categorized according to the etiology of biliary obstruction into 7 groups: malignant stricture 52.2% (36 patients), calcular 24.6% (17 patients), iatrogenic 5.8% (4 patients), portahepatis lesions 5.8% (4 patients), benign stricture 4.3% (3 patients), inflammatory 4.3% (3 patients), and congenital 1.4% (1 patient). The malignant group shows dominant mass, moderate biliary obstruction, and arterial and venous enhancement. The overall sensitivity was 94% for malignancy. Conclusion MDCT cholangiography is non-invasive, fast, and highly sensitive and specific in the diagnosis of different causes and levels of biliary obstruction and is useful in the characterization of the lesion in cases of malignant obstruction and differentiating it from benign stricture. It can be used as an effective alternative to ERCP or PTC.

A new simple endoscopic incision therapy for refractory benign oesophageal anastomotic stricture

Oesophageal anastomotic stricture is a frequent complication after esophagectomy. In most cases, endoscopic bougination or balloon dilation usually resolves anastomotic stricture. However, some refractory oesophageal strictures remain difficult to treat and cause significant morbidity. Recently, successful treatment using endoscopic incisional therapy has been reported in several cases. We report a case of refractory benign oesophageal anastomotic stricture after oesophagectomy. A 72-year-old man underwent three consecutive bouginations. However, he developed progressive stricture. Stricture was successfully treated with an endoscopic knife incision. We performed only three incisions without a cutting method, which was new compared with previous reports. A new simple endoscopic incision technique is effective and safe for stricture management. In conclusion, endoscopic incisional therapy may be recommended as a salvage treatment for properly selected patients with refractory benign stricture who do not respond to conventional therapy.

Diseases of the oesophagus

Defective conduit function of the oesophagus readily induces clinical symptoms and may have serious effects on nutrition and the lungs, the latter resulting from aspiration of gastro-oesophageal contents. Oesophageal pain and dysphagia caused by diseases of the muscular layer or epithelium are often disabling. The oesophagus is exposed to numerous hostile environments including carcinogens in food or those derived from tobacco, betel nuts, and other ingested sources and hence carcinomas can occur. Chronic reflux disease from exposure to corrosive upper gastrointestinal secretions is also associated with malignant disease—adenocarcinoma—as well as benign stricture formation related to the action of pepsin.

Comparative study of oesophageal stricture balloon dilatation with and without triamcinolone 1% intralesional injection

Background: The objective of the study was to effect of steroids in the long term outcome of esophageal benign stricture after endoscopic balloon dilation in terms of recurrence.Methods: With purposive sampling, 50 cases were taken in these studies who were admitted with strictures at any location along the esophagus and of any size at New Civil Hospital, Surat. The indoor patients for a three year period were retrieved using a prepared case sheet proforma on the basis of the patient’s demographic profile and clinical findings. Patients had undergone endoscopic balloon dilation for esophageal benign stricture. In 25 patients endoscopic dilation was followed by submucosal injection of long-acting steroid triamcinolone and the remaining 25 patients were taken as a control.Results: All patients have normal dietary intake including solid food at the time of discharge. All patients under study were regularly followed quarterly. Overall stricture recurrence can be reduced by intralesional triamcinolone injection providing stricture length <6 cm. Stricture >6 cm required a repeated procedure or other treatment modalities, In study group duration between endoscopic dilatation sessions fell significantly over a post dilatation period of 3 to 12 months.Conclusions: In addition to endoscopic dilatation, intralesional trimicinolone injection is safe, effective and significantly decrease stricture rate and decrease endoscopic dilatation sessions.