COMPARATIVE OUTCOMES OF ERCP IN BENIGN VERSUS MALIGNANT BILIARY OBSTRUCTION
Main Article Content
Keywords
ERCP, biliary obstruction, benign disease, malignant disease
Abstract
Background: The causes of biliary obstruction include choledocholithiasis, which is a non malignant condition, and malignant conditions like cholangiocarcinoma or pancreatic cancer. ERCP is a common procedure that is undertaken in diagnosing and managing these obstructions and depending on the type of obstruction, the results vary.
Objectives: The purpose of this work is to assess the success rate, endoscopic modalities and complications of ERCP in cases of benign and malignant blockage of common bile duct.
Study design : A prospective study
Place and duration of study: July 2023 to December 2023 Jinnah Postgraduate Medical Centre, Karachi Gastroenterology Department.
Methods: A prospective study was done in 100 patients of Biliary obstruction 50 benign and 50 malignant. After performing the ERCP on the patients, various factors were documented which include; success rate of the procedure, any adverse effects that may have occurred after the procedure and final results. Data analysis included using mean, standard deviation and ‘P’ value in order to determine the differences between the two groups.
Results: In the benign group, the overall success rate of ERCP was 92 % and the overall complication rate was 8%. In the malignant group it was 78% of success and 18% complications. The length of the hospital stay was 3. 4 (±1. 1) for benign group and 5. 2 (±1. 5) days for the malignant group. There was found statistical significance of the complication rate difference, p=0. 03.
Conclusions: ERCP is very beneficial in both primary benign and malignant biliary strictures, but patients with malignant strictures have greater complication rates and hospital stays than patients with benign strictures. Hence early management and rigorous screening of the patients involved will go a long way in ensuring better results are achieved.
Objectives: The purpose of this work is to assess the success rate, endoscopic modalities and complications of ERCP in cases of benign and malignant blockage of common bile duct.
Study design : A prospective study
Place and duration of study: July 2023 to December 2023 Jinnah Postgraduate Medical Centre, Karachi Gastroenterology Department.
Methods: A prospective study was done in 100 patients of Biliary obstruction 50 benign and 50 malignant. After performing the ERCP on the patients, various factors were documented which include; success rate of the procedure, any adverse effects that may have occurred after the procedure and final results. Data analysis included using mean, standard deviation and ‘P’ value in order to determine the differences between the two groups.
Results: In the benign group, the overall success rate of ERCP was 92 % and the overall complication rate was 8%. In the malignant group it was 78% of success and 18% complications. The length of the hospital stay was 3. 4 (±1. 1) for benign group and 5. 2 (±1. 5) days for the malignant group. There was found statistical significance of the complication rate difference, p=0. 03.
Conclusions: ERCP is very beneficial in both primary benign and malignant biliary strictures, but patients with malignant strictures have greater complication rates and hospital stays than patients with benign strictures. Hence early management and rigorous screening of the patients involved will go a long way in ensuring better results are achieved.
References
1. Baron TH, Mallery JS. Selective bile duct cannulation techniques during ERCP: the peril of using a guidewire. Gastroenterology. 2015;148(3):590-593.
2. Dumonceau JM, Andriulli A, Devière J, et al. European Society of Gastrointestinal Endoscopy (ESGE) guideline: prophylaxis of post-ERCP pancreatitis. Endoscopy. 2010;42(6):503-515.
3. Testoni PA, Mariani A, Giussani A, et al. Risk factors for post-ERCP pancreatitis in high- and low-volume centers and among expert and non-expert operators: a prospective multicenter study. Am J Gastroenterol. 2010;105(8):1753-1761.
4. Freeman ML. Adverse outcomes of ERCP. Gastrointest Endosc. 2002;56(6).
5. Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71(3):446-454.
6. Huang RJ, Friedland S, Downes KL, et al. Endoscopic stenting for malignant biliary obstruction: a risk-stratified analysis of adverse events in a real-world cohort. Gastrointest Endosc. 2019;89(5):1124-1132.
7. Sharma VK, Nguyen CC, Crowell MD, et al. A national study of complications after endoscopic retrograde cholangiopancreatography in the United States. Gastrointest Endosc. 2005;61(4):401-407.
8. Weber A, Schmid RM, Prinz C. Diagnostic approaches for cholangiocarcinoma. World J Gastroenterol. 2008;14(26):4131-4136.
9. Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71(3):446-454.
10. Dumonceau JM, Andriulli A, Devière J, et al. European Society of Gastrointestinal Endoscopy (ESGE) guideline: prophylaxis of post-ERCP pancreatitis. Endoscopy. 2010;42(6):503-515.
11. Freeman ML. Adverse outcomes of ERCP. Gastrointest Endosc. 2002;56(6).
12. Lai EC, Mok FP, Tan ES, et al. Endoscopic biliary drainage for severe acute cholangitis. N Engl J Med. 1992;326(24):1582-6.
13. Sharma VK, Nguyen CC, Crowell MD, et al. A national study of complications after endoscopic retrograde cholangiopancreatography in the United States. Gastrointest Endosc. 2005;61(4):401-407.
14. Testoni PA, Mariani A, Giussani A, et al. Risk factors for post-ERCP pancreatitis in high- and low-volume centers and among expert and non-expert operators: a prospective multicenter study. Am J Gastroenterol. 2010;105(8):1753-1761.
15. Weber A, Schmid RM, Prinz C. Diagnostic approaches for cholangiocarcinoma. World J Gastroenterol. 2008;14(26):4131-4136.
16. Huang RJ, Friedland S, Downes KL, et al. Endoscopic stenting for malignant biliary obstruction: a risk-stratified analysis of adverse events in a real-world cohort. Gastrointest Endosc. 2019;89(5):1124-1132.
17. Kim HS, Kim SW, Ju CI, et al. Analysis of clinical results of short segment pedicle screw fixation for thoracolumbar burst fractures. J Korean Neurosurg Soc. 2007;42(4):317-21.
18. Zhou ZH, Wang B, Huang YM, et al. Selective extension of short segment fixation for thoracolumbar fractures: a new technique for improved clinical outcomes. Orthop Surg. 2019;11(5):811-7.
19. Baron TH, Mallery JS. Selective bile duct cannulation techniques during ERCP: the peril of using a guidewire. Gastroenterology. 2015;148(3):590-593.
20. Weber A, Schmid RM, Prinz C. Diagnostic approaches for cholangiocarcinoma. World J Gastroenterol. 2008;14(26):4131-4136.
2. Dumonceau JM, Andriulli A, Devière J, et al. European Society of Gastrointestinal Endoscopy (ESGE) guideline: prophylaxis of post-ERCP pancreatitis. Endoscopy. 2010;42(6):503-515.
3. Testoni PA, Mariani A, Giussani A, et al. Risk factors for post-ERCP pancreatitis in high- and low-volume centers and among expert and non-expert operators: a prospective multicenter study. Am J Gastroenterol. 2010;105(8):1753-1761.
4. Freeman ML. Adverse outcomes of ERCP. Gastrointest Endosc. 2002;56(6).
5. Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71(3):446-454.
6. Huang RJ, Friedland S, Downes KL, et al. Endoscopic stenting for malignant biliary obstruction: a risk-stratified analysis of adverse events in a real-world cohort. Gastrointest Endosc. 2019;89(5):1124-1132.
7. Sharma VK, Nguyen CC, Crowell MD, et al. A national study of complications after endoscopic retrograde cholangiopancreatography in the United States. Gastrointest Endosc. 2005;61(4):401-407.
8. Weber A, Schmid RM, Prinz C. Diagnostic approaches for cholangiocarcinoma. World J Gastroenterol. 2008;14(26):4131-4136.
9. Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71(3):446-454.
10. Dumonceau JM, Andriulli A, Devière J, et al. European Society of Gastrointestinal Endoscopy (ESGE) guideline: prophylaxis of post-ERCP pancreatitis. Endoscopy. 2010;42(6):503-515.
11. Freeman ML. Adverse outcomes of ERCP. Gastrointest Endosc. 2002;56(6).
12. Lai EC, Mok FP, Tan ES, et al. Endoscopic biliary drainage for severe acute cholangitis. N Engl J Med. 1992;326(24):1582-6.
13. Sharma VK, Nguyen CC, Crowell MD, et al. A national study of complications after endoscopic retrograde cholangiopancreatography in the United States. Gastrointest Endosc. 2005;61(4):401-407.
14. Testoni PA, Mariani A, Giussani A, et al. Risk factors for post-ERCP pancreatitis in high- and low-volume centers and among expert and non-expert operators: a prospective multicenter study. Am J Gastroenterol. 2010;105(8):1753-1761.
15. Weber A, Schmid RM, Prinz C. Diagnostic approaches for cholangiocarcinoma. World J Gastroenterol. 2008;14(26):4131-4136.
16. Huang RJ, Friedland S, Downes KL, et al. Endoscopic stenting for malignant biliary obstruction: a risk-stratified analysis of adverse events in a real-world cohort. Gastrointest Endosc. 2019;89(5):1124-1132.
17. Kim HS, Kim SW, Ju CI, et al. Analysis of clinical results of short segment pedicle screw fixation for thoracolumbar burst fractures. J Korean Neurosurg Soc. 2007;42(4):317-21.
18. Zhou ZH, Wang B, Huang YM, et al. Selective extension of short segment fixation for thoracolumbar fractures: a new technique for improved clinical outcomes. Orthop Surg. 2019;11(5):811-7.
19. Baron TH, Mallery JS. Selective bile duct cannulation techniques during ERCP: the peril of using a guidewire. Gastroenterology. 2015;148(3):590-593.
20. Weber A, Schmid RM, Prinz C. Diagnostic approaches for cholangiocarcinoma. World J Gastroenterol. 2008;14(26):4131-4136.
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Published
Sep 23, 2024
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How to Cite
Dr. Mukhtar Ahmed, Dr. Mashal Rasool, Dr. Hadees, Dr. Ali Raza, Dr. Naseer Ahmad, & Dr. Abdul Malik. (2024). COMPARATIVE OUTCOMES OF ERCP IN BENIGN VERSUS MALIGNANT BILIARY OBSTRUCTION. Journal of Population Therapeutics and Clinical Pharmacology, 31(9), 2866-2872. https://doi.org/10.53555/j3x97q04
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Author Biographies
Dr. Mukhtar Ahmed
Post Graduate Resident FCPS General Surgery Jinnah Postgraduate Medical Centre, Karachi.
Dr. Mashal Rasool
Post Graduate Resident FCPS Neurosurgery Jinnah Postgraduate Medical Centre, Karachi.
Dr. Hadees
Post Graduate Resident FCPS General Surgery Jinnah Postgraduate Medical Centre, Karachi.
Dr. Ali Raza
Post Graduate Resident FCPS General Surgery Pakistan Institute of Medical Sciences, Islamabad.
Dr. Naseer Ahmad
Post Graduate Resident FCPS General Medicine Bolan Medical Complex Hospital Quetta/ Sandeman Provincial Hospital, Quetta. Contact no: 0333-7918009
Dr. Abdul Malik
Post Graduate Resident FCPS General Medicine Bolan Medical Complex Hospital Quetta/ Sandeman Provincial Hospital, Quetta
How to Cite
Dr. Mukhtar Ahmed, Dr. Mashal Rasool, Dr. Hadees, Dr. Ali Raza, Dr. Naseer Ahmad, & Dr. Abdul Malik. (2024). COMPARATIVE OUTCOMES OF ERCP IN BENIGN VERSUS MALIGNANT BILIARY OBSTRUCTION. Journal of Population Therapeutics and Clinical Pharmacology, 31(9), 2866-2872. https://doi.org/10.53555/j3x97q04