Multidisciplinary Approach to Malignant Biliary Obstruction
| Autor: | Robert W. Tenney, Derek Taeyoung Kim, Pawan Rastogi, Uzma Rahman, Jacob Cynamon, Yosef Golowa, Oleandro A. Cercio Roa |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Endoscopic ultrasound
medicine.medical_specialty Endoscopic retrograde cholangiopancreatography medicine.diagnostic_test business.industry General surgery medicine.medical_treatment Gastroenterology Stent Biliary Stenting Percutaneous transhepatic cholangiography Review article 03 medical and health sciences surgical procedures operative 0302 clinical medicine Multidisciplinary approach 030220 oncology & carcinogenesis medicine 030211 gastroenterology & hepatology Radiology Nuclear Medicine and imaging Surgery Biliary decompression business |
| Zdroj: | Digestive Disease Interventions. :323-333 |
| ISSN: | 2472-873X 2472-8721 |
| Popis: | Treatment of malignant biliary obstruction (MBO) requires the coordination of multiple specialties, including oncologists, surgeons, gastroenterologists, and interventional radiologists. If the tumor is resectable, surgical candidates can usually proceed to surgery without preoperative biliary drainage. For patients who undergo biliary drainage, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) combined with biliary stenting are techniques with comparable technical success and mortality, each with distinct advantages and risks. Advances in endoscopic ultrasound allow drainage in patients with challenging anatomy. There are a multitude of devices used for biliary decompression. Self-expanding metal stents (SEMS), with longer patency rates, are in most instances preferred over plastic stents for MBO, especially in patients with life expectancy more than 3 to 4 months. Advantages of covered SEMS versus uncovered SEMS remain controversial as covered stents can prevent tumor ingrowth but at the expense of potential increase in stent migrations. Extra-anatomic biliary drainage using lumen-apposing metal stents is an emerging technique which shows promise when conventional ERCP fails. It is imperative to understand these techniques when tailoring a treatment strategy. The goal of this article is to discuss a multidisciplinary approach for MBO to promote comprehensive care using case examples to highlight essential principles. |
| Databáze: | OpenAIRE |
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