• Endoscopic retrograde cholangiopancreatography drainage for palliation of malignant hilar biliary obstruction - stent-in-stent or side-by-side? (wjgnet.com)
  • Biliary obstruction refers to the blockage of any duct that carries bile from the liver to the gallbladder or from the gallbladder to the small intestine. (medscape.com)
  • The major signs and symptoms of biliary obstruction result directly from the accumulation of bilirubin and bile salts in the blood and the failure of bile to reach its proper destination. (medscape.com)
  • The clinical setting of cholestasis or failure of biliary flow may be due to biliary obstruction by mechanical means or by metabolic factors in the hepatic cells. (medscape.com)
  • For the sake of simplicity, the primary focus of this article is mechanical causes of biliary obstruction, further separating them into intrahepatic and extrahepatic causes. (medscape.com)
  • Overall, gallstones are the most common cause of biliary obstruction. (medscape.com)
  • The lack of bilirubin in the intestinal tract is responsible for the pale stools typically associated with biliary obstruction. (medscape.com)
  • We retrospectively evaluated the factors associated with successful bilateral self-expanding metal stent (SEMS) placement using the partial stent-in-stent (PSIS) method for malignant hilar biliary obstruction and also assessed the safety and efficacy of this technique. (kagoshima-u.ac.jp)
  • 32 males and 15 females) underwent PSIS placement for malignant hilar biliary obstruction in our hospital. (kagoshima-u.ac.jp)
  • Malignant distal biliary obstruction: a systemic review and meta-analysis of endoscopic and surgical bypass results. (thieme-connect.com)
  • Endoscopically applied radiofrequency ablation appears to be safe in the treatment of malignant biliary obstruction. (thieme-connect.com)
  • Intraductal endoscopic radiofrequency ablation for the treatment of hilar non-resectable malignant bile duct obstruction. (thieme-connect.com)
  • INTRODUCTION Interventional radiologists first became involved in the management of malignant obstruction of the biliary tree in the late 1960s, when Kaude et al.1 introduced nonsurgical biliary drainage. (kipdf.com)
  • BILIARY DRAINAGE FOR MALIGNANT STRICTURES Biliary obstruction is potentially fatal because of the adverse pathologic effects including depressed immunity, impaired phagocytic activity, reduced Kupffer cell function, and paucity of bile salts reaching the gut, with consequent endotoxemia, septicemia, and renal failure. (kipdf.com)
  • Most patients with malignant obstructive jaundice caused by carcinoma of the gallbladder, carcinoma of the pancreas, and cholangiocarcinoma present with advanced disease2,3 and only 20% to 30% of such tumors are resectable at the time of diagnosis.2,4 Palliation of the malignant obstruction relieves the patient of itching and jaundice, reduces the risk of infection and septicemia, and generally improves the quality of life. (kipdf.com)
  • It is advocated by some surgeons in certain circumstances before curative resection, however, as a method of correcting metabolic derangements produced by biliary obstruction prior to surgery. (kipdf.com)
  • ROLE OF IMAGING BEFORE PALLIATIVE BILIARY DRAINAGE Because the method of management of malignant biliary obstruction depends on the resectability of the underlying tumor, patients should undergo accurate staging of the disease. (kipdf.com)
  • Conclusion: The modified fully covered SEMS may be useful to prevent stent migration in patients with distal malignant biliary obstruction. (gsk-3signaling.com)
  • Stents can be placed via endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) to relieve biliary obstruction. (medscape.com)
  • Main Recommendations 1 ESGE recommends the use of endoscopic ultrasound-guided biliary drainage (EUS-BD) over percutaneous transhepatic biliary drainage (PTBD) after failed endoscopic retrograde cholangiopancreatography (ERCP) in malignant distal biliary obstruction when local expertise is available. (amsterdamumc.org)
  • 2 ESGE suggests EUS-BD with hepaticogastrostomy only for malignant inoperable hilar biliary obstruction with a dilated left hepatic duct when inadequately drained by ERCP and/or PTBD in high volume expert centers. (amsterdamumc.org)
  • 6 ESGE recommends EUS-guided gastroenterostomy (EUS-GE), in an expert setting, for malignant gastric outlet obstruction, as an alternative to enteral stenting or surgery. (amsterdamumc.org)
  • Palliative stenting to relieve biliary obstruction can be performed at the time of evaluation. (medscape.com)
  • Current percutaneous biliary interventions include percutaneous transhepatic cholangiography (PTC) and biliary drainage to manage benign[1] and malignant obstruction and percutaneous cholecystostomy. (medscape.com)
  • In patients with non resectable lesions, palliation of the biliary obstruction can be either by surgical bypass or non surgical procedures. (annalsofafricansurgery.com)
  • Gallbladder and bile duct tumors can cause extrahepatic biliary obstruction. (merckmanuals.com)
  • Symptoms may be absent but often are constitutional or reflect biliary obstruction. (merckmanuals.com)
  • Mechanical bile drainage can often relieve pruritus, recurrent sepsis, and pain due to biliary obstruction. (merckmanuals.com)
  • For inflammatory bowel disease patients with altered DNA repair functions, the progression from PSC to cholangiocarcinoma may be a consequence of DNA damage resulting from biliary inflammation and bile acids. (wikipedia.org)
  • Introduction: Cholangiocarcinoma (CCA) is a malignant tumor of the biliary epithelium with a poor prognosis. (bvsalud.org)
  • Efficacy of metal and plastic stents in unresectable complex hilar cholangiocarcinoma: a randomized controlled trial. (thieme-connect.com)
  • Systematic review and meta-analysis of the role of vascular resection in the treatment of hilar cholangiocarcinoma. (cancercentrum.se)
  • Klatskin's tumor (or hilar cholangiocarcinoma) is an extra-hepatic cholangiocarcinoma arising in the junction of the main right and left hepatic bile ducts. (unizg.hr)
  • Cholangiocarcinoma is a rare malignant neoplasm and accounts for only 3% of gastrointestinal tumours. (unizg.hr)
  • Hilar cholangiocarcinoma. (medscape.com)
  • EUS-guided fine-needle aspiration of suspected hilar cholangiocarcinoma in potentially operable patients with negative brush cytology. (medscape.com)
  • A Novel Endoscopic Approach to Brachytherapy in the Management of Hilar Cholangiocarcinoma. (medscape.com)
  • Bile duct cancer or cholangiocarcinoma is a cancerous (malignant) growth in one of the ducts. (blogspot.com)
  • Primary malignancies of the biliary tree and surrounding organs that cause Malignant Obstructive Jaundice (MOJ) include Cholangiocarcinoma, ampullary carcinoma, carcinoma of the head of pancreas and rarely gall bladder carcinoma. (annalsofafricansurgery.com)
  • Cholangiocarcinoma may arise in the intrahepatic (least common), perihilar, or distal (extrahepatic) biliary tree. (gastrotraining.com)
  • Tissue diagnosis of cholangiocarcinoma is difficult because it is highly desmoplastic tumour composed of a few malignant cholangiocytes within excessive fibrous tissue. (gastrotraining.com)
  • Cholangiocarcinoma is a tumor that arises as a result of differentiation of the cholangiocytes and can develop from anywhere in the biliary tree. (mdpi.com)
  • Subtypes of cholangiocarcinoma are differentiated based on their location in the biliary tree. (mdpi.com)
  • Cholangiocarcinoma (CCA) is a highly malignant tumor originating from the intra- or extra-hepatic bile ducts that has shown increasing morbidity and mortality rates worldwide in the last few years [ 1 ]. (aging-us.com)
  • PURPOSE: Major liver resection and radical lymph node dissection has been accepted as a definite treatment of choice for hilar cholangiocarcinoma (HC). (koreamed.org)
  • Radiofrequency ablation combined with biliary stent placement versus stent placement alone for malignant biliary strictures: a systemic review and meta-analysis. (thieme-connect.com)
  • He also has a special interest in complex biliary problems including recurrent pyogenic cholangitis and post liver transplant strictures. (sc-ctsi.org)
  • In patients with strictures below the hilum of the liver, endoscopic drainage achieves a high rate of success, is associated with fewer complications than percutaneous intervention, and avoids the discomfort of a percutaneous biliary catheter. (kipdf.com)
  • The majority of strictures of the mid and lower common bile ducts, which are mainly caused by carcinoma of the head of the pancreas, can be drained effectively by the endoscopic approach.5 Many hilar biliary strictures are difficult to treat endoscopically, however, and are best dealt with interventional radiologic techniques.6 The indications for PTBD are summarized in Table 15.1. (kipdf.com)
  • Cardiovasc Intervent Radiol (CVR-2014-0204) Improved accuracy of percutaneous biopsy using cross and push technique for patients suspected with malignant biliary strictures. (drmehmetinal.com)
  • School of Medicine, Soonchunhyang University School of Medicine, SoonChunHyang University School of Medicine, Soonchunhyang University School of Medicine Objective: Endoscopic bilateral metallic stenting has been introduced as feasible and effective palliative modality in patients with inoperable hilar malignant biliary strictures (MBS). (gsk-3signaling.com)
  • Other applications include cholangioplasty for biliary strictures, biopsy of the biliary duct, and management of complications from laparoscopic cholecystectomy and liver transplantation. (medscape.com)
  • Palliative measures such as resection, radiation therapy (e.g., brachytherapy or external-beam radiation therapy), or stenting procedures may maintain adequate biliary drainage and allow for improved quality of life. (tri-kobe.org)
  • Bilateral biliary drainage decreases the risk of cholangitis, but bilateral endoscopic metallic stenting is technically challenging. (kagoshima-u.ac.jp)
  • Surgical, endoscopic, and interventional radiologic (IR) percutaneous techniques are available for biliary drainage. (kipdf.com)
  • Because of the lower morbidity and mortality associated with ERC and percutaneous transhepatic biliary drainage (PTBD) compared to surgical methods, surgery is now rarely employed for palliative purposes. (kipdf.com)
  • Because most patients undergo endoscopic retrograde cholangiopancreaticogram (ERCP) during the diagnostic workup for obstructive jaundice endoscopic insertion of biliary endoprostheses is performed more often than percutaneous drainage. (kipdf.com)
  • Preoperative Percutaneous Transhepatic Biliary Drainage The practice of PTBD prior to surgery is controversial. (kipdf.com)
  • Either internal/external biliary drainage catheters or more plastic stents are inserted 2 to 6 weeks prior to elective surgery. (kipdf.com)
  • Adequate biliary drainage can be achieved in a high percentage of cases. (medscape.com)
  • PDT is effective in restoring biliary drainage and improving quality of life in patients with nonresectable disseminated cholangiocarcinomas. (medscape.com)
  • Life-threatening infection (cholangitis) may occur that requires immediate antibiotic intervention and aggressive biliary drainage. (medscape.com)
  • During the 1970s, percutaneous biliary drainage (PBD) for obstructive jaundice and percutaneous treatment of stone disease was introduced. (medscape.com)
  • For descriptions of other biliary interventions, see Percutaneous Cholangiography, Percutaneous Biliary Drainage, and Biliary Stenting. (medscape.com)
  • Intervention services provided by the department include percutaneous drainage of abdominal collections, percutaneous transhepatic biliary drainage (PTBD) and trans-hepatic arterial chemoembolization (TACE). (edu.in)
  • The intervention procedures are being performed as a part of pre-operative biliary drainage or as permanent palliation. (edu.in)
  • Many surgeons proceed directly to laparotomy without preoperative biliary drainage. (gastrotraining.com)
  • Hendriquez R, Keihanian T, Goyal J, Abraham RR, Mishra R, Girotra M. Radiofrequency ablation in the management of primary hepatic and biliary tumors. (wjgnet.com)
  • Hepatic resection in 485 R0 pT2 and pT3 cases of advanced carcinoma of the gallbladder: results of a Japanese Society of Biliary Surgery survey--a multicenter study. (cancercentrum.se)
  • Bile duct tumors that involve the common hepatic duct bifurcation are referred to as Klatskin tumors regardless of whether they arise from the intrahepatic or extrahepatic portion of the biliary tree. (gastrotraining.com)
  • Malignant hepatic hilar tumors: Can ultrasonography be used as an alternative to angiography with CT arterial portography for determination of resectability? (mskcc.org)
  • Hepatic adenoma is a common benign liver mass with malignant potential that frequently occurs in women of childbearing age. (drpapoulas.com)
  • Hepatic adenoma of any size in men requires liver resection due to high probability of malignant transformation. (drpapoulas.com)
  • Primary hepatic leiomyosarcoma (PHL) is a rare malignant tumor, which originates from smooth muscles. (koreamed.org)
  • The area of HPB surgery focuses on complex operative procedures related to liver, pancreas and biliary tract. (edu.in)
  • The aim of this study was to LDE225 evaluate the feasibility and efficacy of repetitive endoscopic revision after first endoscopic revision for hilar MBS previously managed by bilateral stent-in-stent placement with cross-wired metallic stents. (gsk-3signaling.com)
  • stents (BONASTENT-M Hilar, Standard Sci Tech., Seoul, Korea) were required repetitive biliary reintervention because of stent occlusion after first endoscopic revision during follow up. (gsk-3signaling.com)
  • Conclusion: Repetitive endoscopic revision for hilar MBS previously managed by bilateral metallic stenting was feasible. (gsk-3signaling.com)
  • Cross-wired metallic stents for hilar MBS may facilitate repetitive endoscopic revision after stent occlusion. (gsk-3signaling.com)
  • 8 ESGE suggests that endoscopic ultrasound-directed transgastric ERCP (EDGE) can be offered, in expert centers, to patients with a Roux-en-Y gastric bypass following multidisciplinary decision-making, with the aim of overcoming the invasiveness of laparoscopy-assisted ERCP and the limitations of enteroscopy-assisted ERCP. (amsterdamumc.org)
  • Endoscopic therapy with stent placement can temporarily relieve blockages in the biliary ducts and relieve jaundice in patients. (blogspot.com)
  • [ 1 ] In contrast, bile duct tumors located outside of the liver had been classified with gallbladder cancer as extrahepatic biliary tract tumors. (tri-kobe.org)
  • The biliary system consists of a network of ducts that carry bile from the liver to the small bowel and is classified by its anatomic location (Figure 1 ). (tri-kobe.org)
  • Cholangiocarcinomas (CCCs) are malignancies of the biliary duct system that may originate in the liver and extrahepatic bile ducts, which terminate at the ampulla of Vater. (medscape.com)
  • Lee et al retrospectively enrolled 75 patients who had undergone liver transpalantation and found that although MDCT in the late period should be interpreted with caution in patients with suspected biliary complication, MDCT is a reliable diagnostic technique for the identification of early and late abdominal complications after liver transplantation. (medscape.com)
  • A) Axial T2-weighted Magnetic Resonance Image (MRI) and (B) coronal T2-weighted MRI show a hyperintense mass (black arrow) located at the perihilar area, with marked intrahepatic biliary dilatation in the adjacent liver (the metastatic lesion at segmental VII of the liver was not shown here). (oncologyradiotherapy.com)
  • The size of the mass can vary from 1-20 cm in diameter and the risks of malignant transformation into hepatocellular carcinoma liver cancer increases significantly at 4 cm. (drpapoulas.com)
  • A liver biopsy is contraindicated to avoid severe intraabdominal bleeding.Hemangiomas have no risk of malignant transformation. (drpapoulas.com)
  • Biliary cytadenoma or mucinous cystic neoplasm of the liver is an uncommon premalignant cystic lesion, which accounts for less than 5% of all intrahepatic biliary cysts and occurs primarily in middle aged women with a peak incidence in the 50s. (drpapoulas.com)
  • Due to the potential for malignant transformation to cystadenocarcinoma (cancer), this mass requires a complete surgical removal via liver resection or pericystectomy. (drpapoulas.com)
  • Overview of Biliary Function The liver produces about 500 to 600 mL of bile each day. (merckmanuals.com)
  • Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal ENDOSCOPY (ESGE) clinical guideline. (thieme-connect.com)
  • Comparative performance of uncoated, self-expanding metal biliary stents of different designs in 2 diameters: final results of an international multicenter randomized controlled trial. (thieme-connect.com)
  • Radiofrequency ablation for the management of occluded biliary metal stents. (thieme-connect.com)
  • A study by Kida et al found that covered biliary self-expandable metal stents could be safely removed when they become occluded and that patency rates were similar for reintervention and initial stent placement. (medscape.com)
  • With the advent of metallic and plastic internal stents, further applications in the treatment of biliary diseases were developed. (medscape.com)
  • A biliary catheter (red tube) runs through the tumor volume and was used to deliver brachytherapy, which was given in addition to external-beam radiotherapy. (medscape.com)
  • This tumor originates in the biliary epithelium. (msdmanuals.com)
  • Pancreatoblastoma is a malignant exocrine pancreatic tumor that is usually present in childhood. (koreamed.org)
  • 1 2 Immune cells can produce an antitumor immune response and directly kill malignant cells, but they can also be recruited and retrained by tumor cells to facilitate tumor growth and progression. (bmj.com)
  • Cholangiocarcinomas arise from the intrahepatic or extrahepatic biliary epithelium. (medscape.com)
  • 11 Chronic inflammation of the biliary epithelium is thought to play a central role in ICC carcinogenesis. (bmj.com)
  • If ERCP demonstrates a malignant stricture, an endoprosthesis can be inserted immediately after cholangiography. (kipdf.com)
  • Ulusakarya et al [ 11 ] had reported that the median OS of patients with advanced biliary tract cancer treated with first-line FOLFIRINOX was as long as 15 months. (biomedcentral.com)
  • Other biliary tract cancers include gallbladder cancer and cancer of the ampulla of Vater. (wikipedia.org)
  • An increasing incidence of BTC has been observed at all 3 biliary tract subsites, specifically gallbladder cancer (GBC), extrahepatic bile duct cancer (EBDC), and ampulla of Vater cancer (AOVC), especially in high-risk areas [ 4 , 5 ]. (e-epih.org)
  • Background: Most patients with malignant obstructive jaundice (MOJ) present with non-resectable disease. (annalsofafricansurgery.com)
  • Biliary Tract Cancers Biliary Tract Cancers: Extrahepatic Management CHAPTER 15 TARUN SABHARWAL and ANDREAS ADAM INTRODUCTION Interventional radi. (kipdf.com)
  • Biliary tract cancers (BTCs) are rare but highly fatal. (e-epih.org)
  • Ultrasound may demonstrate biliary duct dilatation and larger hilar lesions. (medscape.com)
  • Debate exists about whether preoperative stenting is warranted, but most surgeons believe that preoperative biliary decompression does not alter the outcome of surgery. (medscape.com)
  • What is the role of preoperative biliary decompression? (gastrotraining.com)
  • Results of a Japanese Society of Biliary Surgery Survey: a multicenter study. (cancercentrum.se)
  • Based on its location, bile duct cancer is divided into three groups: Intrahepatic, Perihilar (also called hilar), and Distal. (blogspot.com)
  • Disorders of the biliary tract affect a significant portion of the worldwide population, and the overwhelming majority of cases are attributable to cholelithiasis (gallstones). (medscape.com)
  • Gallstones, concretions formed in the biliary tract, have been suggested as an important risk factor for BTC [ 5 ]. (e-epih.org)
  • Dilated vessels in IgG4-SC were observed significantly more frequently in the extrapancreatic bile duct, especially the hilar bile duct ( P = 0.006). (biomedcentral.com)
  • Bile duct adenoma and biliary papillomatosis. (gastrotraining.com)
  • Post-transplant complications can be categorized into vascular, non-vascular and biliary. (medscape.com)
  • For FNH, complications such as rupture or bleeding are rare and malignant transformation has not been reported. (drpapoulas.com)
  • Other causes of blockage within the ducts include malignancy, infection, and biliary cirrhosis. (medscape.com)
  • This distinct variant of HCC has a characteristic morphology of malignant hepatocytes enmeshed in lamellar fibrous tissue. (msdmanuals.com)
  • Long-standing inflammation, as with primary sclerosing cholangitis (PSC) or chronic parasitic infection, has been suggested to play a role by inducing hyperplasia, cellular proliferation, and, ultimately, malignant transformation. (medscape.com)