Skip to main content Skip to main navigation menu Skip to site footer
  • Register
  • Login
  • Menu
  • Home
  • Current
  • Archives
  • Announcements
  • About
    • About the Journal
    • Submissions
    • Editorial Team
    • Privacy Statement
    • Contact
  • Register
  • Login

Journal of Education, Health and Sport

Dynamics of the serum bilirubin level during bile ducts drainage in patients with hilar tumor stenosis and jaundice
  • Home
  • /
  • Dynamics of the serum bilirubin level during bile ducts drainage in patients with hilar tumor stenosis and jaundice
  1. Home /
  2. Archives /
  3. Vol. 11 No. 3 (2021) /
  4. Research Articles

Dynamics of the serum bilirubin level during bile ducts drainage in patients with hilar tumor stenosis and jaundice

Authors

  • R. Palytsya National Military Medical Clinical Center
  • L. Markulan Bogomolets National Medical University
  • Ie. Tsema Bogomolets National Medical University
  • D. Dubenko Bogomolets National Medical University
  • A. Batiuk Bogomolets National Medical University
  • Ya. Susak Bogomolets National Medical University

DOI:

https://doi.org/10.12775/JEHS.2021.11.03.016

Keywords

obstructive jaundice, Klatskin tumor, externally-internal suprapapillary cholangiostomy, percutaneous transhepatic cholangiostomy, antegrade endobiliary stenting

Abstract

Palliative bile duct decompression with various modifications are currently performed in 75-80% of patients with hilar stenosis caused by the tumor. The main goal of palliative care is to reduce the manifestations of jaundice, intoxication, pain syndrome, prolong life period and improve patient’s conditions for chemotherapy.

Objective: to evaluate the effectiveness of bile ducts antegrade drainage methods by bilirubin reducing in the palliative treatment of patients with jaundice due to hilar stenosis caused by the tumor.

Materials and methods. In a prospective study included 78 patients with hilar obstructive jaundice, who were underwent of palliative antegrade draining of bile ducts: percutaneous transhepatic cholangiostomy (group PTC) - n = 24, externally-internal suprapapillary cholangiostomy (group EISC) - n = 26, percutaneous transhepatic antegrade endobiliary stenting (group PTAES) - n = 28. Endpoints of the study: total serum bilirubin before the procedure, after 3, 7 days and every 10 days for two months. The mean values of bilirubin and the average percentage of decrease in its value at each of the control periods were evaluated in relation to the initial level. Also, at the same time, the cumulative percentage of patients in which bilirubin had a value of ≤34.2 μmol / L (2 mg / dL) or ≤ 85.5 μmol / L (5 mg / dL) was assessed - the threshold values at which a certain type of chemotherapy is possible.

Results. In all groups, there was a decrease in the average values of bilirubin levels with an increase in the time passed after the procedure. At all control periods, the mean bilirubin values and the percentage of decrease in the mean bilirubin values did not differ statistically between groups (all p < 0.05). The highest rates of decrease in the level of bilirubin were observed during the first 10 days (about 60.0%). From the 10th to the 60th day, the decrease in the level of bilirubin was approximately 20% from the initial one. The cumulative percentage of patients with the bilirubin level on the 60th day ≤ 34.1 μmol / l (2 mg / dl) was 45.8% in the EISC group, 64.5% in the PTC group, and 63.9% in the PTAES group (p = 0.257) in a month these indicators were 11.7%, respectively; 12.5% and 17.9% (all p <0.05). The decrease in the level of bilirubin ≤ 85.5 μmol / L (5 mg / dL) was more rapid. So, already after 10 days, the cumulative percentage of such patients in the groups exceeded 50.0%: 58.3% in the EISC group, 63.6% in the PTC group, 57.7 % in the PTAES group (p = 0.26) in a month these indicators were respectively 83.3%; 77.3% and 80.8%, after two months, respectively 91.7%, 86.4 and 100% (p = 0.80).

Conclusions. The methods of transcutaneous bile ducts drainage/stenting effectively reduce the level of total bilirubin in patients with obstructive jaundice due to hilar stenosis caused by tumor and have no statistically significant differences in the dynamics of bilirubin level within two months of observation.

References

Sahinli H., Özet A. Prognostic and predictive factors in cancer patients with obstructive jaundice treated by percutaneous transhepatic biliary drainage: A single center experience J. of Cancer Research and Therapeutics. 2020; Dec; 16 (Supplement): S99-S103. DOI: 10.4103/jcrt.JCRT_521_19.

Vugt, J. L. A. et al. The prognostic value of portal vein and hepatic artery involvement in patients with perihilar cholangiocarcinoma. HPB/ 2018; 20: 83–92. doi: 10.1016/j.hpb.2017.08.025.

Jarnagin WR, Fong Y, DeMatteo RP et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg. 2001; 234(4):507–517. doi: 10.1097/00000658-200110000-00010.

Banales, J. M. et al. Expert consensus document: cholangiocarcinoma: current knowledge and future perspectives consensus statement from the European Network for the Study of Cholangiocarcinoma (ENS-CCA). Nat. Rev. Gastroenterol. Hepatol. 2016; 13: 261–280. doi: 10.1038/nrgastro.2016.51. Epub 2016 Apr 20.

Levy JL, Sudheendra D, Dagli M, Mondschein JI, Stavropoulos SW, Shlansky-Goldberg RD, Trerotola SO, Teitelbaum U, Mick R, Soulen MC Percutaneous biliary drainage effectively lowers serum bilirubin to permit chemotherapy treatment. Abdom Radiol (NY). 2016; 41 (2): 317-23. doi: 10.1007/s00261-015-0580-z.

Dumonceau JM, Tringali A, Papanikolaou I, et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – updated October 2017. Endoscopy. 2018;50(09):910– 930. doi:10.1055/a-0659-9864.

Rerknimitr R, Angsuwatcharakon P, Ratanachu E et al. Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma. J Gastroenterol. 2013;28:593–607. doi: 10.1111/jgh.12128.

Khan SA, Davidson BR, Goldin R et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: Consensus document. Gut 2002; 51(Suppl 6): VI1–9.

Mayhew D, Mendonca V, Murthy BVS. A review of ASA physical status – historical perspectives and modern developments. Anaesthesia. 2019; 74: 373-9. PMID: 30648259

Thornton RH, Ulrich R, Hsu M, et al. Outcomes of patients undergoing percutaneous biliary drainage to reduce bilirubin for administration of chemotherapy. J Vasc Interv Radiol.2012; 23:89–95 DOI: 10.1016/j.jvir.2011.09.022

Eklund JW, Trifilio S, Mulcahy MF. Chemotherapy dosing in the setting of liver dysfunction. Oncology (Williston Park). 2005; 19:1057–106. PMID: 16131047

Riaz A, Pinkard JP, Salem R, Lewandowski RJ. Percutaneous management of malignant biliary disease. J Surg Oncol. 2019; 120(1):45-56. doi: 10.1002/jso.25471.

Yu H, Yuanyuan S, Guo Z, Xing W, Si T, Guo X, Liu F. Multifactorial analysis of biliary infection after percutaneous transhepatic biliary drainage treatment of malignant biliary obstruction. J Cancer Res Ther. 2018;14(7):1503-1508. doi: 10.4103/jcrt.JCRT_256_18.

Delden OM, Laméris JS Percutaneous drainage and stenting for palliation of malignant bile duct obstruction. Eur Radiol. 2008 Mar; 18(3):448-56.PMID: 17960388

Bismuth H., Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surgery, gynecology & obstetrics. 1975; 140 (2): 170-178. PMID 1079096

Saluja SS, Gulati M, Garg PK, et al. Endoscopic or percutaneous biliary drainage for gallbladder cancer: a randomized trial and quality of life assessment. Clin Gastroenterol Hepatol. 2008;6:944–950.doi: 10.1016/j.cgh.2008.03.028.

Paik WH, Park YS, Hwang JH, et al. Palliative treatment with self-expandable metallic stents in patients with advanced type III or IV hilar cholangiocarcinoma: a percutaneous versus endoscopic approach. Gastrointest Endosc. 2009;69:55–62. PMID: 18657806

Kloek JJ, Na V DG, Aziz Y et al.Endoscopic and percutaneous preoperative biliary drainage in patients with suspected hilar cholangiocarcinoma. J Gastrointest Surg. 2010; 14: 119–125. PMID: 19756881

Walter T, Ho CS, Horgan AM, Warkentin A, et all. Endoscopic or percutaneous biliary drainage for Klatskin tumors? J Vasc Interv Radiol. 2013 Jan; 24(1): 113-21. doi: 10.1016/j.jvir.2012.09.019.

Schmassmann A, Gunten E, Knuchel J et all. Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival. Am J Gastroenterol. 1996; 91: 654 659. PMID: 8677925

Zhang GY, Li WT, Peng WJ, Li GD, He XH, Xu LC. Clinical outcomes and prediction of survival following percutaneous biliary drainage for malignant obstructive jaundice. Oncol Lett. 2014 Apr;7(4):1185-1190. doi: 10.3892/ol.2014.1860

Jang SI, Hwang JH, Lee KH et al. Percutaneous biliary approach as a successful rescue procedure after failed endoscopic therapy for drainage in advanced hilar tumors. J. Gastroenterol. Hepatol. 2017; 32: 932–938. doi: 10.1111/jgh.13602.

Zhang JX, Liu J, Wang B, Liu S, Zu QQ, Shi HB. Retrospective comparison of different percutaneous approaches to manage occluded primary uncovered self-expandable metal stents in patients with unresectable malignant hilar biliary obstruction. Scand J Gastroenterol. 2019 Nov;54(11):1397-1402. doi: 10.1080/00365521.2019.1683602

Isayama H, Hamada T, Yasuda I, et al. TOKYO criteria 2014 for transpapillary biliary stenting. Dig Endosc. 2015;27(2):259–264. doi: 10.1111/den.12379

Downloads

  • PDF

Published

2021-03-31

How to Cite

1.
PALYTSYA, R., MARKULAN, L., TSEMA, Ie., DUBENKO, D., BATIUK, A. & SUSAK, Ya. Dynamics of the serum bilirubin level during bile ducts drainage in patients with hilar tumor stenosis and jaundice. Journal of Education, Health and Sport [online]. 31 March 2021, T. 11, nr 3, s. 154–167. [accessed 21.3.2023]. DOI 10.12775/JEHS.2021.11.03.016.
  • PN-ISO 690 (Polish)
  • ACM
  • ACS
  • APA
  • ABNT
  • Chicago
  • Harvard
  • IEEE
  • MLA
  • Turabian
  • Vancouver
Download Citation
  • Endnote/Zotero/Mendeley (RIS)
  • BibTeX

Issue

Vol. 11 No. 3 (2021)

Section

Research Articles

License

The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0

Stats

Number of views and downloads: 523
Number of citations: 0

Search

Search

Browse

  • Browse Author Index
  • Issue archive

User

User

Current Issue

  • Atom logo
  • RSS2 logo
  • RSS1 logo

Information

  • For Readers
  • For Authors
  • For Librarians

Newsletter

Subscribe Unsubscribe

Tags

Search using one of provided tags:

obstructive jaundice, Klatskin tumor, externally-internal suprapapillary cholangiostomy, percutaneous transhepatic cholangiostomy, antegrade endobiliary stenting
Up

Akademicka Platforma Czasopism

Najlepsze czasopisma naukowe i akademickie w jednym miejscu

apcz.umk.pl

Partners

  • Akademia Ignatianum w Krakowie
  • Akademickie Towarzystwo Andragogiczne
  • Fundacja Copernicus na rzecz Rozwoju Badań Naukowych
  • Instytut Historii im. Tadeusza Manteuffla Polskiej Akademii Nauk
  • Instytut Kultur Śródziemnomorskich i Orientalnych PAN
  • Karmelitański Instytut Duchowości w Krakowie
  • Państwowa Akademia Nauk Stosowanych w Krośnie
  • Państwowa Akademia Nauk Stosowanych we Włocławku
  • Państwowa Wyższa Szkoła Zawodowa im. Stanisława Pigonia w Krośnie
  • Polskie Towarzystwo Ekonomiczne
  • Polskie Towarzystwo Ludoznawcze
  • Towarzystwo Miłośników Torunia
  • Towarzystwo Naukowe w Toruniu
  • Uniwersytet im. Adama Mickiewicza w Poznaniu
  • Uniwersytet Mikołaja Kopernika
  • Uniwersytet w Białymstoku
  • Uniwersytet Warszawski
  • Wojewódzka Biblioteka Publiczna - Książnica Kopernikańska
  • Wyższe Seminarium Duchowne w Pelplinie / Wydawnictwo Diecezjalne „Bernardinum" w Pelplinie

© 2021- Nicolaus Copernicus University Accessibility statement Shop