Abstract
Malignant obstruction of the biliary tree can occur at different sites; intrahepatic, perihilar, and extrahepatic. Symptoms of biliary obstruction vary significantly from patient to patient but may include right upper quadrant abdominal pain, back or shoulder pain, pruritis, jaundice, acholic stool, dark urine, and fatigue. Less than ten percent of malignancies involving the biliary tree will present with evidence of cholangitis; typical symptoms of biliary obstruction along with fever, chills, or bacteremia. A multidisciplinary team approach involving gastroenterologists, surgeons, interventional radiologists, and oncologists is often required for managing patients with malignant biliary obstruction. This chapter will focus on endoscopic approaches for alleviating biliary obstruction, either as a palliative technique for unresectable tumors or as a bridge to surgery for potentially curable tumors.
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References
Soehendra N, Reynders-Frederix V.Palliative bile duct drainage - a new endoscopic method of introducing a transpapillary drain. Endoscopy. 1980;12:8.
Smith AC, Dowsett JF, Russell RC, Hatfield AR, Cotton PB.Randomised trial of endoscopic stenting versus surgical bypass in malignant low bileduct obstruction. Lancet. 1994;344:1655.
Huibregtse K, Katon RM, Coene PP, Tytgat GN.Endoscopic palliative treatment in pancreatic cancer. Gastrointest Endosc. 1986;32:334.
Siegel JH, Snady H.The significance of endoscopically placed prostheses in the management of biliary obstruction due to carcinoma of the pancreas: results of nonoperative decompression in 277 patients. Am J Gastroenterol. 1986;81:634.
Brandabur JJ, Kozarek RA, Ball TJ, Hofer BO, Ryan JA, Jr., Traverso LW, Freeny PC, Lewis GP.Nonoperative versus operative treatment of obstructive jaundice in pancreatic cancer: cost and survival analysis. Am J Gastroenterol. 1988; 83:1132.
Ducreux M, Liguory C, Lefebvre JF, Ink O, Choury A, Fritsch J, Bonnel D, Derhy S, Etienne JP.Management of malignant hilar biliary obstruction by endoscopy. Results and prognostic factors. Dig Dis Sci. 1992;37:778.
Parsons WG, Hanson BL, Howell DA.Duodenal involvement by pancreatic adenocarcinoma at initial ERCP: Outcome of endoscopic therapy. Gastrointest Endosc. 1995;41:A524.
Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, Moore JP, Fennerty MB, Ryan ME, Shaw MJ, Lande JD, Pheley AM.Complications of endoscopic biliary sphincterotomy [see comments]. N Engl J Med. 1996; 335:909.
Parsons WG, Howell D.Progress in tissue sampling at ERCP. In: Cotton PB, Tygat GN, Williams CB, eds. Annual of Gastrointestinal Endoscopy. 8 ed. London: Current Science; 1995.
Scudera PL, Koizumi J, Jacobson IM.Brush cytology evaluation of lesions encountered during ERCP. Gastrointest Endosc. 1990;36:281.
Ponchon T, Gagnon P, Berger F, Labadie M, Liaras A, Chavaillon A, Bory R.Value of endobiliary brush cytology and biopsies for the diagnosis of malignant bile duct stenosis: results of a prospective study. Gastrointest Endosc. 1995;42:565.
Howell DA, Parsons WG, Jones MA, Bosco JJ, Hanson BL.Complete tissue sampling of biliary strictures at ERCP using a new device. Gastrointest Endosc. 1996;43:498.
Meyerson SM, Geenen JE, Catalano MF, Schmalz MJ, Genen DJ, et al. “Tannenbaum” Teflon stents vs traditional polyethylene stents for treatment of malignant biliary strictures: A multicenter prospective randomized trial. Gastrointest Endosc. 1998;47:A394.
Lawrie BW, Pugh S, Watura R.Bile duct stenting: a comparison of the One-Action Stent introduction system with the conventional delivery system. Endoscopy. 1996;28:299.
Tsang TK, Crampton AR, Bernstein JR, Buto S, Cahan JA.Percutaneousendoscopic biliary stenting in patients with occluded surgical bypass. Am J Med. 1990; 88: 344.
Luman W, Cull A, Palmer KR.Quality of life in patients stented for malignant biliary obstructions. Eur J Gastroenterol Hepatol. 1997:9:481.
Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, Liguory C, Nickl N.Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37:383.
Sherman S, Lehman GA.ERCP- and endoscopic sphincterotomy-induced pancreatitis [published erratum appears in Pancreas 1992;7(3):402]. Pancreas. 1991;6: 350.
Andriulli A, Leandro G, Niro G, Mangia A, Festa V, Gambassi G, Villani MR, Facciorusso D, Conoscitore P, Spirito F, De Maio G.Pharmacologic treatment can prevent pancreatic injury after ERCP: a meta-analysis [see comments]. Gastrointest Endosc. 2000;51:1.
Cavallini G, Tittobello A, Frulloni L, Masci E, Mariana A, Di Francesco V.Gabexate for the prevention of pancreatic damage related to endoscopic retrograde cholangiopancreatography. Gabexate in digestive endoscopy-Italian Group [see comments]. N Engl J Med. 1996;335:919.
Parsons WG, Carr-Locke DL. Endoscopic retrograde cholangiopancreatography. In: Beger, ed. The Pancreas: A Clinical Textbook, first edition. Oxford: Blackwell Science; 1998.
Leese T, Neoptolemos JP, Baker AR, Carr-Locke DL.Management of acute cholangitis and the impact of endoscopic sphincterotomy. Br J Surg. 1986;73:988.
Kozarek RA, Ball TJ, Patterson DJ.Endoscopic approach to pancreatic duct calculi and obstructive pancreatitis. Am J Gastroenterol. 1992;87:600.
Sauerbruch T.Endoscopic management of bile duct stones. J Gastroenterol Hepatol. 1992;7:328.
Elton E, Howell DA, Parsons WG, Qaseem T, Hanson BL.Endoscopic pancreatic sphincterotomy: indications, outcome, and a safe stentless technique. Gastrointest Endosc. 1998;47:240.
Foutch PG.A prospective assessment of results for needle-knife papillotomy and standard endoscopic sphincterotomy. Gastrointest Endosc. 1995;41:25.
Aliperti G. Complications related to diagnostic and therapeutic endoscopic retrograde cholangiopancreatography. Gastrointest Endosc Clin N Am. 1996;6:379.
Gould J, Train JS, Dan SJ, Mitty HA.Duodenal perforation as a delayed complication of placement of a biliary endoprosthesis. Radiology. 1988;167:467.
Johanson JF, Schmalz MJ, Geenen JE.Incidence and risk factors for biliary and pancreatic stent migration. Gastrointest Endosc. 1992;38:341.
Tarnasky PR, Cotton PB, Baillie J, Branch MS, Affronti J, Jowell P, Guarisco S, England RE, Leung JW.Proximal migration of biliary stents: attempted endoscopic retrieval in forty-one patients. Gastrointest Endosc. 1995;42:513.
Brown KA, Carpenter S, Barnett JL, Williams DM.Proximal migration of a biliary stent: treatment by combined percutaneous/endoscopic approach. Gastrointest Endosc. 1995;41: 611.
Storkson RH, Edwin B, Reiertsen O, Faerden AE, Sortland O, Rosseland AR.Gut perforation caused by biliary endoprosthesis. Endoscopy. 2000;32:87.
Frakes JT, Johanson JF, Stake JJ.Optimal timing for stent replacement in malignant biliary tract obstruction. Gastrointest Endosc. 1993;39:164.
Chang WH, Kortan P, Haber GB.Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage. Gastrointest Endosc. 1998;47:354.
Motte S, Deviere J, Dumonceau JM, Serruys E, Thys JP, Cremer M.Risk factors for septicemia following endoscopic biliary stenting. Gastroenterology. 1991;101:1374.
Speer AG, Cotton PB, MacRae KD.Endoscopic management of malignant biliary obstruction: stents of 10 French gauge are preferable to stents of 8 French gauge. Gastrointest Endosc. 1988:34:412.
Leung JW, Ling TK, Kung JL, Vallance-Owen J.The role of bacteria in the blockage of biliary stents. Gastrointest Endosc. 1988;34:19.
Ghosh S, Palmer KR.Prevention of biliary stent occlusion using cyclical antibiotics and ursodeoxycholic acid. Gut. 1994;35:1757.
Barrioz T, Ingrand P, Besson I, de Ledinghen V, Silvain C, Beauchant M.Randomised trial of prevention of biliary stent occlusion by ursodeoxycholic acid plus norfloxacin [see comments]. Lancet. 1994;344:581.
Coene PP, Groen AK, Cheng J, Out MM, Tytgat GN, Huibregtse K.Clogging of biliary endoprostheses: a new perspective. Gut. 1990;31:913.
Matsuda Y, Shimakura K, Akamatsu T.Factors affecting the patency of stents in malignant biliary obstructive disease: univariate and multivariate analysis. Am J Gastroenterol. 1991;86:843.
Siegel JH, Lichtenstein JL, Pullano WE, Ramsey WH, Rosenbaum A, Halpern G, Nonkin R, Jacob H.Treatment of malignant biliary obstruction by endoscopic implantation of iridium 192 using a new double lumen endoprosthesis. Gastrointest Endosc. 1988;34:301.
Siegel JH.Improved biliary decompression with large caliber endoscopic prostheses. Gastrointest Endosc. 1984;30:21.
Pedersen FM.Endoscopic management of malignant biliary obstruction. Is stent size of 10 French gauge better than 7 French gauge?Scand J Gastroenterol. 1993; 28:185.
Kadakia SC, Starnes E.Comparison of 10 French gauge stent with 11.5 French gauge stent in patients with biliary tract diseases. Gastrointest Endosc. 1992;38:454.
Leung JW, Chung SC, Sung JY, Li MK.Acute cholecystitis after stenting of the common bile duct for obstruction secondary to pancreatic cancer. Gastrointest Endosc. 1989:35:109.
Huibregtse K, Cheng J, Coene PP, Fockens P, Tytgat GN.Endoscopic placement of expandable metal stents for biliary strictures-- a preliminary report on experience with 33 patients. Endoscopv. 1989:21:280.
Neuhaus H, Hagenmuller F, Classen M. Self-expanding biliary stents: preliminary clinical experience. Endoscopy. 1989;21:225.
Bethge N, Sommer A, von Kleist D, Vakil N.A prospective trial of selfexpanding metal stents in the palliation of malignant esophageal obstruction after failure of primary curative therapy. Gastrointest Endosc. 1996;44:283.
Lammer J, Klein GE, Kleinert R, Hausegger K, Einspieler R.Obstructive jaundice: use of expandable metal endoprosthesis for biliary drainage. Work in progress. Radiology. 1990;177:789.
Neuhaus H, Hagenmuller F, Griebel M, Classen M.Percutaneous cholangioscopic or transpapillary insertion of self- expanding biliary metal stents [see comments]. Gastrointest Endosc. 1991;37:31.
Bethge N, Wagner HJ, Knyrim K, Zimmermann HB, Starck E, Pausch J, Vakil N.Technical failure of biliary metal stent deployment in a series of 116 applications. Endoscopy. 1992;24:395.
Huibregtse K, Carr-Locke DL, Cremer M, Domschke W, Fockens P, Foerster E, Hagenmuller F, Hatfield AR, Lefebvre JF, Liquory CL, et al.Biliary stent occlusion--a problem solved with self-expanding metal stents? European Wallstent Study Group. Endoscopy. 1992;24:391.
Howell DA, Nezhad SF, Dy RM.Endoscopically placed Gianturco endoprosthesis in the treatment of malignant and benign biliary obstruction. Gastrointest Endosc Clin NAm. 1999;9:479.
Ee H, Laurence BH.Haemorrhage due to erosion of a metal biliary stent through the duodenal wall. Endoscopy. 1992;24:431.
Howell D, Shah RJ, Desilets DJ, Parsons WG, Lehman GA, Sherman S, Baillie J, Branch MS, Chuttani R, Pleskow D, Bosco JJ. Multicenter randomized comparative trial of the new spiral Z-stent compared to Wallstent: final results of the ZOOM trial. Gastrointest Endosc. 2001; In press.
Davids PH, Groen AK, Rauws EA, Tytgat GN, Huibregtse K.Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction [see comments]. Lancet. 1992;340:1488.
Prat F, Chapat O, Ducot B, Ponchon T, Pelletier G, Fritsch J, Choury AD, Buffet C.A randomized trial of endoscopic drainage methods for inoperable malignant strictures of the common bile duct [see comments]. Gastrointest Endosc. 1998;47:1.
Hoepffner N, Foerster E. C., EiBing D, Domschke W.Prognostic factors for the palliative treatment of malignant biliary obstruction with Wallstents. Gastrointest Endosc. 1995;41:A416.
Knyrim K, Wagner HJ, Starck E, Herberg A, Pausch J, Vakil N.[Metal or plastic endoprostheses in malignant obstructive jaundice. A randomized and prospective comparison]. Dtsch Med Wochenschr. 1992;117: 847.
Carr-Locke DL, Ball T, Connors PJ, Cotton PB, Geenen DJ, Hawes RH, Jowell P, Kozarek R, Lehman G, Meier R, Ostroff JW, Shapiro MJ, Silvis SE, Vennes J.Multicenter, Randomized Trial of Wallstent Biliary Endoprosthesis versus Plastic Stents. Gastrointestinal Endoscopy. 1993;39:A310.
Nicholson AA, Royston CM.Palliation of inoperable biliary obstruction with self-expanding metal endoprostheses: a review of 77 patients. Clin Radiol. 1993;47:245.
Knyrim K, Wagner HJ, Pausch J, Vakil N.A prospective, randomized, controlled trial of metal stents for malignant obstruction of the common bile duct. Endoscopy. 1993;25:207.
Carr-Locke DL, Roston AD.Endoscopic Therapy for Malignant Biliary Obstruction. In: Jacobson IM, ed. ERCP and Its Applications. Philadelphia: Lippincott-Raven; 1998:225.
Tham TC, Carr-Locke DL, Vandervoort J, Wong RC, Lichtenstein DR, Van Dam J, Ruymann F, Chow S, Bosco JJ, Qaseem T, Howell D, Pleskow D, Vannerman W, Libby ED.Management of occluded biliary Wallstents. Gut. 1998;42:703.
Jackson JE, Roddie ME, Chetty N, Benjamin IS, Adam A.The management of occluded metallic self-expandable biliary endoprostheses. AJR Am J Roentgenol. 1991;157:291.
Born P, Rosch T, Bruhl K, Ulm K, Sandschin W, Frimberger E, Allescher H, Classen M.Long-term results of endoscopic treatment of biliary duct obstruction due to pancreatic disease. Hepatogastroenterology. 1998;45:833.
Rossi P, Bezzi M, Salvatori FM, Panzetti C, Rossi M, Pavia G.Clinical experience with covered wallstents for biliary malignancies: 23-month follow-Up. Cardiovasc Intervent Radiol. 1997;20:441.
Hausegger KA, Thurnher S, Bodendorfer G, Zollikofer CL, Uggowitzer M, Kugler C, Lammer J.Treatment of malignant biliary obstruction with polyurethane-covered Wallstents. AJR Am J Roentgenol. 1998;170:403.
Isayama H, Komatsu Y, Tsujino T, al. e. A prospective randomized study of “covered” vs “uncovered” metallic stent for diatal malignant biliary obstruction. Gastrointest Endosc. 2000; 51:191.
Ponnudurai R, Haber GB, Kortan P, al. e. A new covered biliary Wallstent: effectiveness in the palliation of malignant obstructive jaundice; results from a multicenter trial. Gastrointest Endosc. 2000;51:5641.
Polydorou AA, Cairns SR, Dowsett JF, Hatfield AR, Salmon PR, Cotton PB, Russell RC.Palliation of proximal malignant biliary obstruction by endoscopic endoprosthesis insertion. Gut. 1991;32:685.
Martin JA, Slivka A, Rabinovitz M, Carr BI, Wilson J, Silverman WB.ERCP and stent therapy for progressive jaundice in hepatocellular carcinoma: which patients benefit, which patients don’t?Dig Dis Sci. 1999;44:1298.
Silverman W, Slivka A.New technique for bilateral metal mesh stent insertion to treat hilar cholangiocarcinoma. Gastrointest Endosc. 1996;43:61.
Jowell PS, Cotton PB, Huibregtse K, France HG, Jr., Erickson RV, Aas J, Ostroff JW, Gordon RL.Delivery catheter entrapment during deployment of expandable metal stents. Gastrointest Endosc. 1993;39:199.
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Parsons, W.G., Alasadi, R. (2001). Malignant Biliary Obstruction: Endoscopic Approaches. In: Talamonti, M.S., Pappas, S.G. (eds) Liver-Directed Therapy for Primary and Metastatic Liver Tumors. Cancer Treatment and Research, vol 109. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-3371-6_9
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DOI: https://doi.org/10.1007/978-1-4757-3371-6_9
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