Jaundice is the most common symptom in periampullary cancer or pancreatic head cancer.
Biliary drainage is the primary treatment of various malignant biliary disorders such as pancreatic cancer and cholangiocarcinoma.
Biliary drainage allows for symptom relief of jaundice and pruritus, for normalization of liver functions and allows for diagnosis by biopsy or cytologic brushing.
Biliary drainage is the primary treatment of various malignant biliary disorders such as pancreatic cancer and cholangiocarcinoma.
Biliary drainage allows for symptom relief of jaundice and pruritus, for normalization of liver functions and allows for diagnosis by biopsy or cytologic brushing.
Previously felt that jaundice increased risk of postoperative complications.
Preoperative biliary drainage studies can reduce morbidity and mortality (van der Gaag NA).
Contrary to the above are two meta-analyses of randomized trials that indicate overall complication rate in patients undergoing preoperative biliary drainage was higher than that in patients who went directly to surgery (Wang Q, Sewnath,ME).
Biliary drainage can be achieved by either surgical or non surgical means.
Nonsurgical means is usually preferable given its minimally invasive nature.
Nonsurgical techniques result in shorter inpatient stays and fewer complications.
Two best non-surgical methods of treatment biliary obstruction are endoscopic approach by endoscopic retrograde cholangiopancreatography (ERCP) and per cutaneous transhepatic biliary drainage performed by interventional radiologists.
In a randomized trial a comparison between preoperative biliary train each with surgery alone for patients with cancer of the head of the pancreas: the rates of serious complications were 39% in the surgery group and 74% in biliary drainage group, and surgery related complications occurred in 37% in the early surgery group and 47% biliary group, there was no difference in mortality linked of hospital stay between groups (van der Gaag NA).
Large study comparing endoscopic biliary drainage to percutaneous biliary drainage: the former had fewer adverse events than percutaneous drainage for malignant biliary tract obstruction.
ERCP should be the first-line intervention for pancreatic cancer and cholangiocarcinoma biliary obstruction (Inander S et al.).
In the van der Gaag study comparing surgical outcomes with preoperative ERCP for biliary drainage for 4-6 weeks, followed by surgery compared with surgery alone within one week of diagnosis of potentially resectable pancreatic cancer with biliary obstruction: the initial ERCP procedure failed in 25% of the cases, and after a second ERCP successful biliary drainage was achieved in 94% of the patients, and in the ERCP group 46% of patients experienced pancreatitis, perforation, bleeding and cholangitis.