A Modern Approach to the Choice of Endobiliary Replacement Time in Patients With Obstructive Jaundice of Cancerous Genesis

The aim of the investigation was to determine an optimal time of endobiliary stenting in patients with obstructive jaundice syndrome of cancerous genesis on the comparative analysis basis.

Materials and Methods. We studied the treatment results of 360 patients with obstructive jaundice syndrome of cancerous genesis using minimally invasive techniques. Mean age was 60.0±8.3 years (from 37 to 84 years). The first stage of treatment was biliary decompression using percutaneous external drainage of ducts, the second — the restoration of biliary duct patency and antegrade bile passage using percutaneous stenting. Group 1 consisted of 150 patients with early stenting, group 2 — 210 patients after delayed stenting of biliary passage.

Results. Three groups of complications were found: complications related to the procedure, inflammatory complications, and progressive hepatic failure. In group 1, 23 of 150 patients (15.3%) had complications, in group 2 — 44 of 210 patients (21.9%) (p=0.039). Lethality in an early postoperative period in group 1 was 2.6%, in group 2 — 4.8% (p=0.038). Group 1 had significant and statistically reliable improvement of some laboratory findings.

Conclusion. The most effective and safe technique to help patients with obstructive jaundice of cancerous genesis is an early stenting — within the first three days after external percutaneous biliary drainage.

1. Shevchenko Yu.L., Vetshev P.S., Stoyko Yu.M., et al. Diagnostics and surgical management in obstructive jaundice syndrome. Annaly hirurgiceskoj gepatologii 2008; 13(4): 96–105.
2. Lomakin I.A., Ivanov Yu.V., Sazonov D.V., et al. Diagnostics and management of patients with obstructive jaundice. Klinicheskaya praktika 2012; 3: 42–50.
3. Greenlee R.T., Hill-Harmon M.B., Murray Т., Thun M. Cancer statistics, 2001. Cancer J Clin 2001; 51: 15–36.
4. Ribachkov V.V., Dryazhenkov I.G., Kabanov E.N. Causes of endogenous intoxication in purulent cholangitis. Annaly hirurgiceskoj gepatologii 2009; 14(2): 28–32.
5. Akhaladze G.G. Purulent cholangitis: problems of pathophysiology and treatment. Consilium medicum 2003; 5: 4.
6. Gal’perin E.I., Vetshev P.S. Rukovodstvo po khirurgii zhelchnykh putey [Guidelines on biliary tract surgery]. Moscow: Vidar; 2006; 559 p.
7. Prokubovskiy V.I., Kapranov S.A. Transhepatic biliary duct replacement. Hirurgia 1990; 1; 18–23.
8. Kim H.J., Lee S.K., Kim M.H., Song M.H., Park D.H., Kim S.Y., et al. Percutaneous transhepatic cholangioscope treatment of patients with benign bilio-enteric anastomotic strictures. Gastrointest Endosc 2003; 58(5): 733–738.
9. Vetshev P.S., Stoyko Yu.M., Levchuk A.L., et al. The possibilities of modern diagnostic techniques and validation of management in obstructive jaundice. Vestnik khirurgicheskoy gastroenterologii 2008; 2: 24–32.
10. Gusev A.V., Balagurov B.A., Borovkov I.N., et al. Drainage and replacement of biliary ducts in obstructive jaundice. Vestnik novykh meditsinskiy tekhnologiy 2008; 15(4): 97–98.
11. Izrailov R.E., Kulezneva Yu.V., Xat’kov I.E., et al. The role of interventional radiology in minimally invasive treatment of patients with tumors of biliopancreatobiliary area. Diagnosticheskaya interventsionnaya radiologiya 2011; 5(3): 37–43.
12. Zavrazhnov A.A., Popov A.Yu., Petrovskiy A.N., et al. The significance of minimally invasive bile decompression techniques in the treatment of patients with obstructive jaundice. Neotlozhnaya meditsinskaya pomoshch’ 2012; 2: 54–58.
13. Kulezneva Yu.V., Izrailov R.E., Kapustin V.I. Management of antegrade biliary decompression in patients with obstructive jaundice of cancerous genesis. Vestnik Natsional’nogo mediko-khirurgicheskogo tsentra im. N.I. Pirogova 2010; 5(2): 24–28.
14. Tulin A.I., Zerav S.N., Kupch S.K. Endoscopic and percutaneous transhepatic stenting of bile ducts. Annaly hirurgiceskoj gepatologii 2007; 12(1): 53–61.
15. Shapovalyants S.G., Budzinski S.A., Fedorov E.D., et al. Endoscopic management of the bile ducts postoperative scar strictures (20-year experience). Annaly hirurgiceskoj gepatologii 2011; 16(2): 10–17.
16. Shevchenko Yu.L., Vetshev P.S., Stoiko Yu.M., Priority trends in the obstructive jaundice patients management. Annaly hirurgiceskoj gepatologii 2011; 3: 9–15.

Kalakhanova B.Kh., Chechenin G.М., Lebedev S.S., Barinov Y.V., Seregin А.А., Melkonyan G.G., Mumladze R.B. A Modern Approach to the Choice of Endobiliary Replacement Time in Patients With Obstructive Jaundice of Cancerous Genesis. Sovremennye tehnologii v medicine 2014; 6(4): 97