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Self Expandable Metallic Stents in Malignant Biliary Obstruction: Safety and Efficacy

Authors: Rayadh Asmer Zaydan --- Qasim Lefta Abbas --- Rabah Hiab Asreah
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 1 Pages: 13-17
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT: BACKGROUND: Endoscopic stenting has become widely accepted procedure for the relief of jaundice in patients with malignant biliary obstruction. It may offer lower morbidity and mortality, shorter hospitalization, and diminished overall cost compared with surgical or radiological approaches. OBJECTIVE: To assess the efficacy of the self expendable metallic stents in treatment of the patients with biliary stricture due to malignant tumors, and to compare this efficacy between proximal and distal obstruction. PATIENTS AND METHODS: SEMS were deployed during endocopic retrograde cholangiopancreatography (ERCP) in a total of 41patients with malignant biliary obstruction (proximal or distal) . Clinical success was defined as the improvement of the laboratory data and a decrease of the bilirary dilatation by follow up ultrasound imaging. Stent dysfunction was defined as recurrence of jaundice or cholangitis, is confirmed by ERCP or simply by elevated cholestatic parameters and treated by insertion of a plastic stent or second metallic stent inside the old one. RESULTS: Stent placement was achieved in 38 of 41 patients (92.7%) with malignant bile duct obstruction. SEMS was failed to be placed in 3 patients (1 with pancreatic cancer and 2 with proximal cholangiocarcinoma).Clinical improvement was seen in 36 of 38 patients (94.7%). In 4 patients (10.5%) cholangitis had developed.The overall stent patency time was 37.88 + 18.59 weeks (range 16-76 week). Analysis in subgroup of patients classified according to the site of obstruction (34with distal and 7 with proximal biliary obstruction).The overall success (technical and clinical) was significantly higher in the distal group (33/34, 97.1%) than in the proximal group (3/7, 42.9%); p-value was 0.02. CONCLUSION: SEMS implantation is a feasible , palliative method for inoperable malignant biliary obstruction. The clinical and the technical success of biliary drainage by SEMS is better achieved in distal than in proximal tumors with hilar infiltration by the tumor

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