Treatment of biliary stricture: stents versus surgery

There remained, however, a subset of patients too infirm to tolerate such a procedure. [...]biliary stents first made their debut in the world of gastroenterology in 1979 for palliative measures in nonoperable malignant biliary strictures.1 As techniques were improved, stents were offered to all pat...

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Bibliographic Details
Published in:The American surgeon 2012-12, Vol.78 (12), p.E510-512
Main Authors: Gordon, Elizabeth A, Pullatt, Rana C
Format: Article
Language:English
Subjects:
Adult
Alcoholism - complications
Alcoholism - diagnosis
Anastomosis, Roux-en-Y - methods
Bile
Cholangiopancreatography, Endoscopic Retrograde - adverse effects
Cholangiopancreatography, Endoscopic Retrograde - methods
Cholestasis - diagnostic imaging
Cholestasis - etiology
Cholestasis - surgery
Cysts
Device Removal - methods
Diabetes Mellitus - diagnosis
Diabetes Mellitus - drug therapy
Drainage - methods
Family medical history
Follow-Up Studies
Hospitals
Humans
Jejunostomy - methods
Liver - surgery
Male
Mortality
Nutrition
Ostomy
Pancreas
Pancreatitis, Chronic - complications
Pancreatitis, Chronic - diagnosis
Pancreatitis, Chronic - therapy
Parenteral nutrition
Patients
Postoperative Complications - physiopathology
Postoperative Complications - therapy
Risk Assessment
Stents
Studies
Surgery
Treatment Outcome
Citations: Items that this one cites
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Summary:There remained, however, a subset of patients too infirm to tolerate such a procedure. [...]biliary stents first made their debut in the world of gastroenterology in 1979 for palliative measures in nonoperable malignant biliary strictures.1 As techniques were improved, stents were offered to all patients as an alternative to invasive surgery. Studies have shown that patients with advanced pancreatic cancer have a 70 to 90 per cent chance of developing biliary obstruction.3 Given the high mortality rate of this disease process and of a highly invasive surgery on these patients, metallic stents that did not migrate and did not need to be replaced offered an attractive alternative to plastic stents in this patient population.3 However, metal stents are quickly incorporated into the biliary tree, and epithelial hyperplasia secondary to chronic inflammation will prevent the stent from being removed. [...]metallic stent occlusion requires either placement of a second stent to attempt to reopen the tract or a surgical biliary bypass procedure.
ISSN:0003-1348
1555-9823
DOI:10.1177/000313481207801206