Portal de Periódicos da CAPES

Stent fracture in malignant biliary obstruction

1993; Elsevier BV; Volume: 39; Issue: 6 Linguagem: Inglês

10.1016/s0016-5107(93)70301-6

1097-6779

Daniel G. Donahue, John R. Saltzman, Peter E. Krims,

Pancreatic and Hepatic Oncology Research

with disease activity benefited from the treatment.This suggests that the presence of active inflammation should not dissuade an attempt at dilation.In our report, the main interval since the last surgery was 1.9 years in patients in whom treatment failed, whereas it was 8.5 years in those with good outcomes.This suggests that patients in the former group could have a biologically more aggressive form of disease and this might be more important for long-term outcome.The need for repeat dilations to achieve and maintain freedom from symptoms is clearly a disadvantage of the method.However, the endoscopic treatment was very well tolerated and preferred to surgery by most patients.In extreme, one of our patients repeatedly refused surgery and instead underwent 11 dilations during a 2-year period, each offering only a short relief.Interestingly, after the last procedure the patient remained without symptoms for a prolonged period of time.Similarly, in Leuven one patient had lasting relief only after three relatively unsuccessful treatments.This shows that in some treatment failures repeat procedure may eventually result in a prolonged improvement.Dilations with balloons may be painful, and proper premedication is important.However, in my experience there is no need for general anesthesia, which might be important from an economic point of view.Moreover, the procedure can safely be performed on an outpatient basis.Certainly, complications may emerge, and it is thus essential to keep the patient for observation for about 4 hours after the procedure.However, the frequency of complications is reasonably low, and most of these will occur within the 4-hour observation period.Nonetheless, patients who are old and frail, who live far from the hospital, or who do not understand instructions are better treated as inpatients.An important detail may be rigorous bowel preparation before the procedure to reduce contamination of the peritoneal cavity should perforation occur.