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At least 19 recordsLinked to original sources
PubMed1976

Operative endoscopy in the management of biliary tract neoplasms.

Operative endoscopy of the biliary system has been employed with ever increasing frequency at the UCLA Hospital during the last three years. In addition to its established value with respect to disclosing unsuspected stones in the bile ducts, choledochoscopy has been of great value in terms of more accurate diagnosis and staging of periampullary and bile duct neoplasms. It has been observed that many biliary tract carcinomas are multicentric in origin and that cholangiography is not adequate to identify small intrahepatic ductal lesions. More than one cell type of bile duct carcinoma may be present in the same patient. Choledochoscopy should be used in addition to the conventional criteria for resectability in all patients with ductal or periampullary carcinoma. Use of this technic will spare some patients needless radical procedures and should improve long-term cure rates by identifying those patients with truly localized disease for curative resections.

Adenocarcinoma↗
PubMed1991

[Surgical treatment of cancer of the biliary tract and gall bladder].

With the advances in various kinds of diagnostic methods and improvement of operative technique, operations for cancer in biliary tract have recently increased, however, the prognosis has been unsatisfied. During the past 25 years, 495 cases with carcinoma of biliary tract (ca of gall bladder 175 cases, ca of bile duct 201, and ca of papilla vater 105) were operated. The resectability rate was 66% (62% in gall bladder, 62% in bile duct, 84% in papilla vater). Among the lesions in bile duct, the resectable rate in lower bile duct was better than the other site in bile duct. The late results in ca of bile duct, especially in the lesion of upper bile duct were still poor, however, the 5-years survival rate in ca of gallbladder or papilla vater carcinoma was 61% or 56%, respectively. For the further improvement of the surgical results, the sufficient resection of the intrahepatic bile duct in ca of bile duct should be performed, and in gall bladder carcinoma when tumor extends into the neck of gall bladder, bile duct should be resected. In advanced carcinoma, the appropriate hepatectomy or bile duct resection should be considered in proportion to the operative influence and the extension of the tumor.

Biliary Tract Neoplasms↗
PubMed1991

[Trends of management of carcinoma of the biliary tract].

Trends of management of carcinoma of the biliary tract are described. Ultrasonography has made it possible to perform non-invasive and routine examination for biliary disorders and to find early cancer of the gallbladder. Moreover, endoscopic ultrasonography has enabled to make a differential diagnosis and a staging diagnosis. Percutaneous transhepatic cholangioscopy has been used as the most precise diagnostic procedure and peroral cholangioscopy has been introduced as a more convenient endoscopy. Although percutaneous transhepatic biliary drainage is considered to be hazardous and disadvantageous procedure in Western countries, it is essential in Japan where radical and extended operation are frequently performed. In Japan, major hepatectomies, pancreatoduodenectomy and/or combined resections of major vessels are aggressively adopted for advanced gallbladder cancers. However, such operations are still much dangerous and long-term survivors are few. Therefore, application of these extended operation for this advanced disease should be carefully re-examined. Various hepatectomies with caudate loberesection have been performed for patients with carcinoma of the hepatic hilus. Liver transplantation is also attempted for this disease, however, not accepted generally. Pylolus preserving pancreatoduodenectomy is now being accepted for biliary malignancies, which brings excellent quality of life.

Biliary Tract Neoplasms↗
PubMed1991

[Endoscopic retrograde cholangiopancreatography and biliary prosthesis].

Endoscopic retrograde cholangio-pancreatography (ERCP) confirms the diagnosis of obstructive jaundice and sometimes provides the histological proof that the stenosis is due to cancer. Palliative treatment of biliary and pancreatic cancers is indicated when the extension of the tumour is such that it precludes any oncologically satisfactory excision, in patients at high operative risk, when jaundice recurs after surgery and in cases of biliary metastases from distant cancers. Cancers located below the hilum are usually easily treated by endoscopic insertion of a biliary stent, whereas hilar cancers extending to the bifurcation often require combined endoscopic and percutaneous techniques to drain all liver segments. The most frequent of early complications of biliary stents is cholangitis, notably in hilar cancers. Late complications, notably obstruction of the stent, can be reduced by using expandable metal stents.

Biliary Tract Neoplasms↗
PubMedDate not supplied

[Internal biliary diversions in inoperable neoplasms of the biliary tract and pancreas].

The authors report their experience with the treatment of mechanical jaundice in inoperable malignant neoplasms of the bile ducts and pancreas. They emphasize the importance of intrahepatic peripheral biliodigestive derivations (Soupault and Couinaud operation). After a review of the international literature, the authors consider the value of on accurate surgical strategy even in the presence of pathological and clinical features which may limit a radical choice.

Adult↗
PubMed1977

Operative choledochoscopy. Results of a prospective study in several institutions.

A prospective study from six surgical units utilizing choledochoscopy in conjunction with primary choledocholithotomyand cholangiography resulted in an incidence of less than 2 per cent unsuspected residual biliary calculi. Total reliance on choledochoscopy without associated operative cholangiography is not justified and fraught with error. When there are no calculi in the common duct, the choledochoscope allows the surgeon to shorten exploration time with confidence that the postexploratory cholangiogram will confirm his negative findings. The choledoschoscope is of additional value in the extraction of calculi. Certain considerations in the management of biliary tract tumors also can be helped by the addition of choledochoscopy. The simultaneous presence of calculous disease and biliary tract neoplasm can coexist can be brought to light by the use of the choledochoscope. The incorporation of choledochoscopy, using a rigid Berci-Shore choledochoscope, as part of routine common duct exploration, appears to be warranted.

Adolescent↗
PubMed1990

Radioimmunolocalization of tumours of the pancreas and biliary tree.

Although localization of tumours by radiolabelled antibodies is in principle a specific method, in practice the technique is dependent upon qualitative and quantitative differences in antigen expression between malignant and benign tissue. Pancreatic disease is similar to other gastrointestinal malignancies in which RIL has been evaluated. The expression of a small number of antigens has been demonstrated to enable some differentiation between pancreatic cancer and principally chronic pancreatitis. To date the cross-reactivity of antibodies has resulted in limited specificity but it does appear that CEA, CA19-9, TAG-72 and BW494 are appropriate target antigens. Studies in RIL have indicated that BW494 has the optimal characteristics, although studies with chronic pancreatitis are limited. Further information on the fate of the administered antibody and the interactions with tumour-associated antigen is required before clinical application can be considered. At present this technique does not have a role in primary diagnosis. In the near future, however, RIL may prove useful as a complementary investigation to conventional methods particularly in the assessment of recurrent malignancy.

Adenocarcinoma↗
PubMed1992

Clinical evaluation of a new serum tumour marker CA 242 in pancreatic carcinoma.

The aim of this study was to evaluate the new monoclonal tumour marker CA 242 in the diagnosis of pancreatic carcinoma and to compare it with the established markers CA 50 and CEA. Serum concentrations were determined in 113 patients with jaundice, in 20 patients with laboratory values suggesting cholestasis, and in 60 patients with a suspicion to have chronic pancreatitis. Twenty-four of these 193 patients had pancreatic carcinoma and two patients had carcinoma of papilla of Vater. The sensitivities of CA 242, CA 50 and CEA were 80.7%, 96.1%, and 92.3%, respectively. The specificities were 79.0%, 58.0%, and 59.2%. The sensitivities of combinations of CA 50 and CEA with CA 242 did not exceed the sensitivity of CA 50 alone. The specificity of CA 242 was improved by combining it with CEA (92.2%). The serum marker CA 242 seems to be less sensitive than CEA and CA 50 in the detection of pancreatic carcinoma, but it may prove useful because of its high specificity.

Adenoma, Bile Duct↗
PubMed1990

Malignant common bile duct obstruction: factors influencing the success rate of endoscopic drainage.

The problems encountered in draining the bile ducts endoscopically in 148 patients with malignant obstruction of the mid or distal common bile duct and/or the papilla were assessed. Endoscopically visible extrinsic invasion of the papilla by a malignancy in the pancreatic head, with or without duodenal stenosis, appeared to be the major reason for the failure to insert a stent. The larger a tumor in the pancreatic head the greater the chance of invasion of the papillary region. This appeared to be evident for tumors restricted to the non-uncinate region of the pancreatic head. We would recommend primary percutaneous biliary drainage or surgery when the size of a proven malignancy restricted to the non-uncinate region of the pancreatic head is 5 cm or more, or when diagnostic duodenoscopy reveals extrinsic invasion of the papilla of Vater, or severe duodenal involvement with stenosis.

Adenoma, Bile Duct↗
PubMed1979

[Surgery in patients with obstructive jaundice caused by carcinoma (author's transl)].

Malignant disease obstructing the bile ducts is diagnosed in most cases at a time, when radical surgery is not possibly any more. Diagnostic procedures applied up to now are not suited for early diagnosis. 5 years survival rates of patients with carcinoma of the bile ducts are maximally 6%, in patients with carcinoma of the papilla 36%. In the Department of Surgery of the Münster University, 126 such patients have been treated in the recent time; in 104 cases jaundice was apparent clinically. Radical pancreatoduodenectomy could be done only in 24 patients.

Adult↗