Document Detail

Long-term outcome in patients with advanced hilar bile duct tumors undergoing palliative endoscopic or percutaneous drainage.
MedLine Citation:
PMID:  10923359     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Advanced tumors of the hepatic duct bifurcation (Klatskin tumors) present problems to the endoscopist in deciding which procedure to use for palliative treatment of the resulting cholestasis--endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage (PTBD), or both. There are technical difficulties with all forms of treatment for stenoses in the hilar region and intrahepatic bile ducts, and there are as yet no clear data on which type of drainage is feasible or preferable. SUBJECTS: 59 consecutive patients (30 men, 29 women; mean age 71 years) underwent palliative treatment for malignant hilar bile duct tumors of Bismuth stages II-IV during a three-year period (1992-94). METHOD: A retrospective analysis was carried out, and long-term follow-up data were obtained from telephone interviews with the patients, relatives, or referring physicians. RESULTS: The 59 patients were treated using ERCP (n = 20) or PTBD (n = 39). Three died within 30 days, and six were lost to follow-up. Clinically adequate drainage was achieved in 78% (n = 46) of the total patient group. Patient survival was a median of six months (range 0.5-38), and was slightly longer when the primary drainage procedure was successful (7.5 months). Initial complications occurred in 11% after ERCP and in 33% after PTBD, with a 30-day mortality of 5%. After the initial intervention, five patients who received ERCP treatment had to be switched to PTBD during the longer-term course. Three of these five patients died within 30 days of the PTBD insertion. CONCLUSIONS: Palliative treatment in patients with advanced Klatskin tumors is still suboptimal, even when combined endoscopic and percutaneous techniques are used in the same institution, allowing treatment to be tailored to the individual patient's needs. There is therefore a need for improvements in existing forms of treatment, as well as for the development of new forms of treatment.
P Born; T Rösch; K Brühl; W Sandschin; N Weigert; R Ott; E Frimberger; H D Allescher; W Hoffmann; H Neuhaus; M Classen
Related Documents :
21366709 - Single vs. fractionated photodynamic therapy for face and scalp actinic keratoses: a ra...
21482009 - Severe qtc prolongation under mild hypothermia treatment and incidence of arrhythmias a...
18333059 - New technique in hepatic parenchymal transection for living related liver donor and liv...
18350609 - Model for end-stage liver disease score versus child score in predicting the outcome of...
21511459 - Towards industrially-feasible delignification and pitch removal by treating paper pulp ...
21269349 - Sequential treatment with triple combination cream and intense pulsed light is more eff...
20484119 - Will warfarin ever be replaced?
14743199 - Chronic graft-versus-host disease: where do we go from here?
22552789 - Prospective study of postoperative sensory disturbances after surgical treatment of man...
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Zeitschrift für Gastroenterologie     Volume:  38     ISSN:  0044-2771     ISO Abbreviation:  Z Gastroenterol     Publication Date:  2000 Jun 
Date Detail:
Created Date:  2000-10-19     Completed Date:  2000-10-19     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0033370     Medline TA:  Z Gastroenterol     Country:  GERMANY    
Other Details:
Languages:  eng     Pagination:  483-9     Citation Subset:  IM    
Department of Internal Medicine II, Technical University of Munich, Rechts der Isar Hospital, Germany.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Aged, 80 and over
Bile Duct Neoplasms / mortality,  pathology,  therapy*
Cholangiopancreatography, Endoscopic Retrograde
Cholestasis, Extrahepatic / mortality,  pathology,  therapy*
Hepatic Duct, Common* / pathology
Klatskin's Tumor / mortality,  pathology,  therapy*
Middle Aged
Neoplasm Staging
Palliative Care*
Retrospective Studies
Survival Rate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Activation of mitogen-activated protein kinases in different models of pancreatic acinar cell damage...
Next Document:  Synchronous herpes simplex virus and cytomegalovirus esophagitis.