Obstructive jaundice caused by pancreatic head malignancies are there predictive factors for successful endoscopic biliary stenting?

Endoscopic retrograde cholangiopancreatography provides precise imaging of malignant biliopancreatic strictures and allows palliative treatment with endoscopic stenting. Initial successful biliary stenting can be achieved in about 69-100% of patients with pancreatic head malignancies. Preliminary data from our Clinic reported a much lower success rate of endoscopic biliary stenting in obstructive jaundice caused by pancreatic head malignancies. These findings may be because patients are referred at more advanced stages, which could contribute to the lower success rate of biliary stenting. We aimed to determine the success rate of endoscopic biliary stenting prospectively in 50 patients with pancreatic head malignancies and to asses if clinical, laboratory and ultrasound findings can be predictive of success and safety in biliary stenting. Initial successful biliary stenting was achieved in 70% of our patients. No major complications (perforation, severe pancreatitis, massive bleeding, death) were noted. We were able to identify factors predictive of a lower success rate which were associated with a more advanced disease and a longer delay before treatment. Based on our results, we conclude that ERCP should be offered without delay as a primary treatment option for all patients with unresectable pancreatic head malignancy and as a possible treatment option in patients with resectable malignancy who are poor candidates for surgery.

Helicobacter pylori and gastric carcinoma.

The aim of the study was to evaluate the relation of Helicobacter pylori (HP) infection and gastric cancer and a possible relation with a certain histopathological type of gastric cancer and localization within the stomach. A cross-section study was conducted on 60 consecutive patients (45 men and 15 women) with an established histological diagnosis of gastric cancer. The patients were divided into 2 groups (HP positive and HP negative) and additionally, depending on histopathological type, into intestinal, diffuse and cardia cancer, and localization as cardia carcinoma, proximal and distal carcinoma. HP was detected with a rapid ureasa endoscopic test and a serologic immune essay. Forty-two out of 60 patients 42 (70%) were HP positive. There were 36 intestinal type of gastric cancer, 34 (94.4%) HP positive (statistically significant), 19 patients with diffuse type, and 8 (42.1%) HP positive. The remaining 5 were carcinoma of cardia and all were HP negative. Thirty-seven (61.7%) were distal carcinomas, up to (76.2%) in the HP positive group, there were 18 (30%) proximal carcinomas and 5 (8.3%) localized on the cardia. This study confirmed the high incidence of HP infection in patients with gastric carcinoma, particularly in those with an intestinal type of cancer. Carcinomas were predominantly localized in the distal part of the stomach, especially in the HP positive group of intestinal type. Carcinomas of cardia were negatively associated with HP infection.