Malignant biliary strictures. Diagnosis and management.
OBJECTIVE
To identify the cause, methods of diagnosis and management of malignant biliary strictures in our institution and compare with studies from other communities.


METHODS
From March 1998 through to August 2002, we reviewed 1000 files of patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) at the Gastroenterology unit, King Khalid University Hospital in Riyadh, Kingdom of Saudi Arabia for malignant biliary strictures (MBS). Clinical, laboratory data, method of diagnosis and management were recorded.


RESULTS
Seventy-two patients (72/1000) with MBS were encountered. Forty one (57%) were males and 31 (43%) were females and the majority were Saudi nationals (82%). Jaundice and right upper quadrant pain were the most frequent symptoms in 84.7% and 52.8% of patients. Cholangiocarcinoma was present in 31 (43%) and pancreatic adenocarcinoma in 23 (31.9%) patients. Other malignancies found included gallbladder carcinoma in 5 patients (6.9%), ampullary carcinoma in 5 (6.9%), metastatic liver carcinoma in 4 patients (5.6%), hepatocellular carcinoma in 2 (2.8%) and lymphoma in 2 (2.8%). The diagnosis was entertained mainly by ERCP (93%). Endoscopic palliation was carried out in 77.8% of patients, percutaneous transhepatic drainage in 13.9% and surgery in 6 (8.3%). The mean survival was higher for the endoscopic compared to the percutaneous transhepatic and surgery groups (6.9 +/- 4.13, 4.27 +/- 4.29 and 3.67 +/- 2.65 months).


CONCLUSIONS
In non-resectable tumors, ERCP is the optimal method of diagnosis and palliation of MBS.
Al-Mofleh
Ibrahim A
IA
Gastroenterology Division, Department of Medicine (59), King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia.
Al-Rashed
Rashed S
RS
Al-Amri
Saleh M
SM
Al-Ghamdi
Abdullah S
AS
Al-Faleh
Faleh Z
FZ
Al-Freihi
Hussein M
HM
Isnani
Arthur C
AC
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D001707:Biopsy, Needle; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012529:Saudi Arabia; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome