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Endoscopic management of biliary malignancy and outcome

Author: 
Akmat Ali, Richmond Ronald Gomes, Zakiul Hassan, Abu Hena Abid Zafr, Khadiza Begum and Muhammad Ehsan Jalil

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is being used as a safe therapeutic tool for the palliative management of biliary and pancreatic malignancy. This study was conducted to evaluate the clinical outcome of patients with pancreatico-biliary malignancy admitted to our study hospital after endoscopic stenting.
Methods: We retrospectively identified patients who underwent ERCP stenting for biliary and pancreatic malignancy during January 2013 through December, 2015 at Crescent Gastroliver and General Hospital, Dhaka.
Results:We identified 311 patients who had biliary and pancreatic malignancy and underwent ERCP for stenting. Among 311, 124 (40%) had periampullary carcinoma, 112 (36%) had cholangiocarcinoma, 43 (14%) had carcinoma gall bladder and 28 (9%) had carcinoma head of the pancreas. Mean age of the patients was 56 years and more than half-58.1% (181/311) were male. Of 311, stenting was compete/successful for 274 (88%) and of these free flow of bile was established in 263 (96%) patients. Majority were introduced with single plastic stent. Stenting was not possible for 36 patients. Eighteen patients had complete obstruction and tight stricture of CBD, not allowing guide wire to negotiate, 6 cases with periampullay carcinoma and had completely destroyed papilla, 9 had infiltration and invasion to duodenum, not allowing the scope to second part of duodenum and stenting was not feasible for 3 case as right and left hepatic duct and their branches were cut off due to extensive hepatic metastasis. During ERCP, bleeding occurred in 12 patients and none had perforation. Of 274 successful stenting, 257 (94%) had no immediate complication. Only 6 patients developed post-ERCP pancreatitis and 11 patients developed post-ERCP cholangitis. At one month follow up 6 patients developed jaundice and restenting was done.
Conclusion: ERCP stenting can be used as a safe and effective palliative care option to improve the quality of life for Biliary and Pancreatic cancer patients.

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