White Bile in Malignant Biliary Obstruction: A Poor Prognostic Marker.
Ontology highlight
ABSTRACT:
SUBMITTER: Gremida A
PROVIDER: S-EPMC5806925 | biostudies-literature | 2018 Jan
REPOSITORIES: biostudies-literature
Publications
White Bile in Malignant Biliary Obstruction: A Poor Prognostic Marker.
Gremida Anas A Rustagi Tarun T
Clinical endoscopy 20171016 1
Similar Datasets
Project description: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.
| S-EPMC7857955 | biostudies-literature
Project description: Not available
| S-EPMC5992785 | biostudies-literature
Project description:BackgroundBiliary leakage is a serious complication of hepato-pancreato-biliary operations, increasing morbidity and mortality, and challenging clinicians.ObjectiveThis study aims to evaluate the incidence of bilioenteric anastomotic leakage, treatment options, and their outcomes at a high-volume tertiary referral center.MethodsA retrospective cohort study was conducted to analyze the outcomes of patients who underwent biliary anastomosis formation between 2016 and 2021. Data from patients with malignant biliary obstruction was analyzed collectively and in two homogenous cohorts: distal malignant (DM) group with distal biliary obstruction undergoing pancreatic head resection, proximal malignant (PM) group with perihilar biliary obstruction undergoing perihilar biliary resection without liver resection.Results724 patients were found. After exclusions, 410 remained in the DM and 41 in the PM group. In the DM group the leak rate was 5.6% (23/410). Mortality was 3.9%, in patients with anastomotic failure 26% (6/23) vs no failure 2.6% (10/387) (p‹0.0001). Leak rate in the ASA III and ASA I-II patients were 52.2% (12/23) vs 48.8% (11/23), (p = 0.597). Leak rates were higher in the PM group 14,6% (6/41), mortality was 4.9% (2/41). All leaks in the PM group occurred in ASA III patients (6/6). No statistically significant associations were found between leak rates and factors such as patient age, preoperative serum bilirubin levels, preoperative or intraoperative biliary drainage, cholangitis, blood transfusion, postoperative pancreatic fistula, or bile duct dilation in either group. Bile leaks (n = 29) were treated conservatively (n = 9) with percutaneous transhepatic drainage (n = 3) or reoperation with (n = 16) or without (n = 10) external biliary drainage. Clinical success rates were slightly higher after reoperation with external drainage.ConclusionThis study identified perihilar resection as a risk factor for biliary leakage and trends indicating higher leak rates among patients with advanced comorbidities (ASA III), elevated preoperative bilirubin levels, non-dilated bile ducts, cholangitis or postoperative pancreatic fistula but these associations did not reach statistical significance, likely due to the limited sample size. In the management of anastomotic leakage, conservative and minimally invasive methods are effective; however, most cases required relaparotomy combined with external biliary drainage.
| S-EPMC11665246 | biostudies-literature
Project description:BackgroundThere are still many controversies about biliary drainage in MBO, and we aimed to summarize and evaluate the evidence associated with biliary drainage.MethodsWe conducted an umbrella review of SRoMAs based on RCTs. Through July 28, 2022, Embase, PubMed, WOS, and Cochrane Database were searched. Two reviewers independently screened the studies, extracted the data, and appraised the methodological quality of the included studies. GRADE was used to evaluate the quality of the evidence.Results36 SRoMAs were identified. After excluding 24 overlapping studies, 12 SRoMAs, including 76 RCTs, and 124 clinical outcomes for biliary drainage in MBO were included. Of the 124 pieces of evidence evaluated, 13 were rated "High" quality, 38 were rated "Moderate", and the rest were rated "Low" or "Very low". For patients with MBO, 125I seeds+stent can reduce the risk of stent occlusion, RFA+stent can improve the prognosis; compared with PC, SEMS can increase the risk of tumor ingrowth and reduce the occurrence of sludge formation, and the incidence of tumor ingrowth in C-SEMS/PC-SEMS was significantly lower than that in U-SEMS. There was no difference in the success rate of drainage between EUS-BD and ERCP-BD, but the use of EUS-BD can reduce the incidence of stent dysfunction. For patients with obstructive jaundice, PBD does not affect postoperative mortality compared to direct surgery. The use of MS in patients with periampullary cancer during PBD can reduce the risk of re-intervention and stent occlusion compared to PC. In addition, we included four RCTs that showed that when performing EUS-BD on MBO, hepaticogastrostomy has higher technical success rates than choledochoduodenostomy. Patients who received Bilateral-ENBD had a lower additional drainage rate than those who received Unilateral-ENBD.ConclusionsOur study summarizes a large amount of evidence related to biliary drainage, which helps to reduce the uncertainty in the selection of biliary drainage strategies for MBO patients under different circumstances.
| S-EPMC10508238 | biostudies-literature
Project description: Not available
| S-EPMC10993820 | biostudies-literature
Project description:BackgroundMalignant Distal Biliary Obstruction (MBDO) is a common event occurring along the natural history of both pancreatic cancer and cholangiocarcinoma. Epidemiological and biological features make MBDO one of the key elements of the clinical management of patients suffering for of pancreatic cancer or cholangiocarcinoma. The development of dedicated biliary lumen-apposing metal stents (LAMS) is changing the clinical work up of patients with MBDO. i-EUS is an Italian network of clinicians and scientists with a special interest in biliopancreatic endoscopy, EUS in particular.MethodsThe scientific methodology was chosen in line with international guidance and in a fashion similar to those applied by broader scientific associations. PICO questions were elaborated and subsequently voted by a broad panel of experts within a simplified Delphi process.Results and conclusionsThe manuscripts describes the results of a consensus conference organized by i-EUS with the aim of providing an evidence based-guidance for the appropriate use of the techniques in patients with MBDO.
| S-EPMC11525304 | biostudies-literature
Project description:ObjectivesTo compare the use of an antireflux metal stent (ARMS) with that of a conventional covered self-expandable metal stent (c-CSEMS) for initial stenting of malignant distal biliary obstruction (MDBO).Materials and methodsWe retrospectively investigated 59 consecutive patients with unresectable MDBO undergoing initial endoscopic biliary drainage. ARMS was used in 32 patients and c-CSEMS in 27. Technical success, functional success, complications, causes of recurrent biliary obstruction (RBO), time to RBO (TRBO), and reintervention were compared between the groups.ResultsStent placement was technically successful in all patients. There were no significant intergroup differences in functional success (ARMS [96.9%] versus c-CSEMS [96.2%]), complications (6.2 versus 7.4%), and RBO (48.4 versus 42.3%). Food impaction was significantly less frequent for ARMS than for c-CSEMS (P = 0.037), but TRBO did not differ significantly between the groups (log-rank test, P = 0.967). The median TRBO was 180.0 [interquartile range (IQR), 114.0-349.0] days for ARMS and 137.0 [IQR, 87.0-442.0] days for c-CSEMS. In both groups, reintervention for RBO was successfully completed in all patients thus treated.ConclusionARMS offers no advantage for initial stent placement, but food impaction is significantly prevented by the antireflux valve.
| S-EPMC5831319 | biostudies-literature
Project description: Not available
| S-EPMC7859654 | biostudies-literature
Project description:Video 1EUS-guided choledochoantrostomy.
| S-EPMC10251679 | biostudies-literature
Project description:Background and objectivesEndoscopic retrograde cholangiopancreatography (ERCP) is the method of choice for drainage in patients with distal malignant biliary obstruction, but it fails in up to 10% of cases. Percutaneous transhepatic cholangiography (PTC) and surgical bypass are the traditional drainage alternatives. This study aimed to compare technical and clinical success, quality of life, and survival of surgical biliary bypass or hepaticojejunostomy (HJT) and endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDT) in patients with distal malignant bile duct obstruction and failed ERCP.Patients and methodsA prospective, randomized trial was conducted. From March 2011 to September 2013, 32 patients with malignant distal biliary obstruction and failed ERCP were studied. The HJT group consisted of 15 patients and the CDT group consisted of 14 patients. Technical and clinical success, quality of life, and survival were assessed prospectively.ResultsTechnical success was 94% (15/16) in the HJT group and 88% (14/16) in the CDT group (P = 0.598). Clinical success occurred in 14 (93%) patients in the HJT group and in 10 (71%) patients in the CDT group (P = 0.169). During follow-up, a statistically significant difference was seen in mean functional capacity scores, physical health, pain, social functioning, and emotional and mental health aspects in both techniques (P < 0.05). The median survival time in both groups was the same (82 days).ConclusionData relating to technical and clinical success, quality of life, and survival were similar in patients who underwent HJT and CDT drainage after failed ERCP for malignant distal biliary obstruction.
| S-EPMC4568637 | biostudies-literature