title: Malignant common bile duct obstruction: factors influencing the success rate of endoscopic drainage.
abstract: The problems encountered in draining the bile ducts endoscopically in 148 patients with malignant obstruction of the mid or distal common bile duct and/or the papilla were assessed. Endoscopically visible extrinsic invasion of the papilla by a malignancy in the pancreatic head, with or without duodenal stenosis, appeared to be the major reason for the failure to insert a stent. The larger a tumor in the pancreatic head the greater the chance of invasion of the papillary region. This appeared to be evident for tumors restricted to the non-uncinate region of the pancreatic head. We would recommend primary percutaneous biliary drainage or surgery when the size of a proven malignancy restricted to the non-uncinate region of the pancreatic head is 5 cm or more, or when diagnostic duodenoscopy reveals extrinsic invasion of the papilla of Vater, or severe duodenal involvement with stenosis.
authors.affiliation: Department of Diagnostic Radiology, University Hospital Rotterdam-Dijkzigt, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Boender
authors.forename: G A
authors.initials: GA
authors.lastname: Nix
authors.forename: H E
authors.initials: HE
authors.lastname: Schütte
authors.forename: J S
authors.initials: JS
authors.lastname: Laméris
authors.forename: M
authors.initials: M
authors.lastname: van Blankenstein
authors.forename: J
authors.initials: J
authors.lastname: Dees
mesh_terms: D002759:Adenoma, Bile Duct / Q000150:complications; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications; D001661:Biliary Tract Neoplasms / Q000150:complications*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000601:surgery*; D003137:Common Bile Duct Diseases / Q000209:etiology / Q000601:surgery*; D004322:Drainage; D004724:Endoscopy; D006801:Humans; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000175:diagnosis; D015607:Stents