Endoscopic stent therapy (EST) for progressive jaundice in hepatocellular carcinoma (HCC) with dominant biliary stricture (DBS)

J. A. Martin, A. Slivka, M. Rabinovitz, B. I. Carr, W. B. Silverman

Research output: Contribution to journalArticle

Abstract

HCC is a major cause of morbidity and mortality in patients with cirrhosis, and treatment options for non-operative patients are limited. New jaundice in these patients may be secondary to progression of underlying hepatic disease, intrahepatic tumor infiltration, tumor compression of the extrahepatic biliary tree, or any combination thereof. Modalities to assess for an obstructive etiology of jaundice include ultrasound (US), CT scan (CT), and ERCP. ERCP may be considered the diagnostic gold-standard, and can provide treatment in the form of endoscopic stents; however, the added expense and morbidity must be considered, particularly if radiologic imaging fails to demonstrate biliary dilation. AIMS: To determine if: 1) US or CT predicts a finding of DBS at ERCP; 2) US or CT identifies patients who will respond to EST; 3) EST is effective in the treatment of jaundice in patients with HCC and DBS. METHODS: Retrospective analysis of 27 patients with biopsyproven HCC who underwent ERCP for evaluation and treatment of progressive jaundice after prior US or CT. Response to EST was a normalization in the bilirubin or a decrease in bilirubin >50%. RESULTS. DBS at ERCP + - n=12 n=15 Duct dilation by US/CT + 8/12 67% 2/15 13% 4/12 33% 13/15 87% Response to EST + - n=6 n=6 Duct dilation by US/CT + 6/6 100% 2/6 33% - 0/6 0% 4/6 67% Only 6/12 (50%) of patients with DBS at ERCP who underwent EST had a significant decline in bilirubin, 3 of whom became eligible for further chemotherapy based on this response. Procedure-related complications occurred in 1/12 (4%). 30-day mortality was 3/12 (25%), none procedure-related. CONCLUSIONS: 1) US or CT was a poor predictor of DBS at ERCP, but accurately predicted lesions which responded to EST. 2) ERCP/EST had no benefit in the absence of duct dilation on US or CT in HCC patients with progressive jaundice. 3) In selected patients, EST can safely relieve jaundice, and allow for subsequent therapy.

Original languageEnglish
Pages (from-to)387
Number of pages1
JournalGastrointestinal Endoscopy
Volume43
Issue number4
Publication statusPublished - 1996

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Jaundice
Stents
Hepatocellular Carcinoma
Pathologic Constriction
Endoscopic Retrograde Cholangiopancreatography
Dilatation
Therapeutics
Bilirubin
Morbidity
Obstructive Jaundice
Mortality
Biliary Tract
Gold
Neoplasms
Fibrosis

ASJC Scopus subject areas

  • Gastroenterology

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Endoscopic stent therapy (EST) for progressive jaundice in hepatocellular carcinoma (HCC) with dominant biliary stricture (DBS). / Martin, J. A.; Slivka, A.; Rabinovitz, M.; Carr, B. I.; Silverman, W. B.

In: Gastrointestinal Endoscopy, Vol. 43, No. 4, 1996, p. 387.

Research output: Contribution to journalArticle

Martin, J. A. ; Slivka, A. ; Rabinovitz, M. ; Carr, B. I. ; Silverman, W. B. / Endoscopic stent therapy (EST) for progressive jaundice in hepatocellular carcinoma (HCC) with dominant biliary stricture (DBS). In: Gastrointestinal Endoscopy. 1996 ; Vol. 43, No. 4. pp. 387.
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title = "Endoscopic stent therapy (EST) for progressive jaundice in hepatocellular carcinoma (HCC) with dominant biliary stricture (DBS)",
abstract = "HCC is a major cause of morbidity and mortality in patients with cirrhosis, and treatment options for non-operative patients are limited. New jaundice in these patients may be secondary to progression of underlying hepatic disease, intrahepatic tumor infiltration, tumor compression of the extrahepatic biliary tree, or any combination thereof. Modalities to assess for an obstructive etiology of jaundice include ultrasound (US), CT scan (CT), and ERCP. ERCP may be considered the diagnostic gold-standard, and can provide treatment in the form of endoscopic stents; however, the added expense and morbidity must be considered, particularly if radiologic imaging fails to demonstrate biliary dilation. AIMS: To determine if: 1) US or CT predicts a finding of DBS at ERCP; 2) US or CT identifies patients who will respond to EST; 3) EST is effective in the treatment of jaundice in patients with HCC and DBS. METHODS: Retrospective analysis of 27 patients with biopsyproven HCC who underwent ERCP for evaluation and treatment of progressive jaundice after prior US or CT. Response to EST was a normalization in the bilirubin or a decrease in bilirubin >50{\%}. RESULTS. DBS at ERCP + - n=12 n=15 Duct dilation by US/CT + 8/12 67{\%} 2/15 13{\%} 4/12 33{\%} 13/15 87{\%} Response to EST + - n=6 n=6 Duct dilation by US/CT + 6/6 100{\%} 2/6 33{\%} - 0/6 0{\%} 4/6 67{\%} Only 6/12 (50{\%}) of patients with DBS at ERCP who underwent EST had a significant decline in bilirubin, 3 of whom became eligible for further chemotherapy based on this response. Procedure-related complications occurred in 1/12 (4{\%}). 30-day mortality was 3/12 (25{\%}), none procedure-related. CONCLUSIONS: 1) US or CT was a poor predictor of DBS at ERCP, but accurately predicted lesions which responded to EST. 2) ERCP/EST had no benefit in the absence of duct dilation on US or CT in HCC patients with progressive jaundice. 3) In selected patients, EST can safely relieve jaundice, and allow for subsequent therapy.",
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T1 - Endoscopic stent therapy (EST) for progressive jaundice in hepatocellular carcinoma (HCC) with dominant biliary stricture (DBS)

AU - Martin, J. A.

AU - Slivka, A.

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AU - Carr, B. I.

AU - Silverman, W. B.

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N2 - HCC is a major cause of morbidity and mortality in patients with cirrhosis, and treatment options for non-operative patients are limited. New jaundice in these patients may be secondary to progression of underlying hepatic disease, intrahepatic tumor infiltration, tumor compression of the extrahepatic biliary tree, or any combination thereof. Modalities to assess for an obstructive etiology of jaundice include ultrasound (US), CT scan (CT), and ERCP. ERCP may be considered the diagnostic gold-standard, and can provide treatment in the form of endoscopic stents; however, the added expense and morbidity must be considered, particularly if radiologic imaging fails to demonstrate biliary dilation. AIMS: To determine if: 1) US or CT predicts a finding of DBS at ERCP; 2) US or CT identifies patients who will respond to EST; 3) EST is effective in the treatment of jaundice in patients with HCC and DBS. METHODS: Retrospective analysis of 27 patients with biopsyproven HCC who underwent ERCP for evaluation and treatment of progressive jaundice after prior US or CT. Response to EST was a normalization in the bilirubin or a decrease in bilirubin >50%. RESULTS. DBS at ERCP + - n=12 n=15 Duct dilation by US/CT + 8/12 67% 2/15 13% 4/12 33% 13/15 87% Response to EST + - n=6 n=6 Duct dilation by US/CT + 6/6 100% 2/6 33% - 0/6 0% 4/6 67% Only 6/12 (50%) of patients with DBS at ERCP who underwent EST had a significant decline in bilirubin, 3 of whom became eligible for further chemotherapy based on this response. Procedure-related complications occurred in 1/12 (4%). 30-day mortality was 3/12 (25%), none procedure-related. CONCLUSIONS: 1) US or CT was a poor predictor of DBS at ERCP, but accurately predicted lesions which responded to EST. 2) ERCP/EST had no benefit in the absence of duct dilation on US or CT in HCC patients with progressive jaundice. 3) In selected patients, EST can safely relieve jaundice, and allow for subsequent therapy.

AB - HCC is a major cause of morbidity and mortality in patients with cirrhosis, and treatment options for non-operative patients are limited. New jaundice in these patients may be secondary to progression of underlying hepatic disease, intrahepatic tumor infiltration, tumor compression of the extrahepatic biliary tree, or any combination thereof. Modalities to assess for an obstructive etiology of jaundice include ultrasound (US), CT scan (CT), and ERCP. ERCP may be considered the diagnostic gold-standard, and can provide treatment in the form of endoscopic stents; however, the added expense and morbidity must be considered, particularly if radiologic imaging fails to demonstrate biliary dilation. AIMS: To determine if: 1) US or CT predicts a finding of DBS at ERCP; 2) US or CT identifies patients who will respond to EST; 3) EST is effective in the treatment of jaundice in patients with HCC and DBS. METHODS: Retrospective analysis of 27 patients with biopsyproven HCC who underwent ERCP for evaluation and treatment of progressive jaundice after prior US or CT. Response to EST was a normalization in the bilirubin or a decrease in bilirubin >50%. RESULTS. DBS at ERCP + - n=12 n=15 Duct dilation by US/CT + 8/12 67% 2/15 13% 4/12 33% 13/15 87% Response to EST + - n=6 n=6 Duct dilation by US/CT + 6/6 100% 2/6 33% - 0/6 0% 4/6 67% Only 6/12 (50%) of patients with DBS at ERCP who underwent EST had a significant decline in bilirubin, 3 of whom became eligible for further chemotherapy based on this response. Procedure-related complications occurred in 1/12 (4%). 30-day mortality was 3/12 (25%), none procedure-related. CONCLUSIONS: 1) US or CT was a poor predictor of DBS at ERCP, but accurately predicted lesions which responded to EST. 2) ERCP/EST had no benefit in the absence of duct dilation on US or CT in HCC patients with progressive jaundice. 3) In selected patients, EST can safely relieve jaundice, and allow for subsequent therapy.

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