ABSTRACT
As recent advances in chemotherapy and surgical treatment have improved outcomes in patients with biliary cancers, the search for an optimal strategy for relief of their obstructive jaundice has become even more important. Without satisfactory relief of biliary obstruction, many patients would be ineligible for treatment. We review all prospective randomized trials and recent retrospective non-randomized studies for evidence that would support such a strategy. For distal malignant biliary obstruction, an optimal strategy would be insertion of metallic stents either endoscopically or percutaneously. Evidence shows that a metallic stent inserted percutaneously has better outcomes than plastic stents inserted endoscopically. For malignant hilar obstruction, percutaneous biliary drainage with or without metallic stents is preferred.
Subject(s)
Humans , Bile Duct Neoplasms/pathology , Biliary Tract Diseases/pathology , Cholangiocarcinoma/pathology , Decompression, Surgical , Drainage/methods , Endoscopy , Evidence-Based Medicine , Hepatic Duct, Common , Jaundice, Obstructive/pathology , Klatskin Tumor/pathology , StentsABSTRACT
To report our experience with percutaneous drainage of hepatic abscesses. Retrospective study of patients with hepatic abscesses seen at 2 institutions: Toronto General Hospital in Toronto, Canada and King Abdulaziz University Hospital in Jeddah, Saudi Arabia over a 7 year period. Complete resolution in 20 out of 22 [91%] patients. Pleural effusions developed in 4 [18%] patients. Death occurred in 2 [9%] patients with multiple abscesses on top of liver malignancy. Procedural related surgical intervention was not required. Radiologically guided percutaneous drainage of hepatic abscesses remains the gold standard approach to liver abscesses. This is in agreement with studies of other authors