The Role of Percutaneous Transhepatic Cholangiography, Endoscopic Retrograde Cholangiopancreatography and Ultrasonography in Evaluation of Obstructive Jaundice

Hasan, Abdulkadir H (1988) The Role of Percutaneous Transhepatic Cholangiography, Endoscopic Retrograde Cholangiopancreatography and Ultrasonography in Evaluation of Obstructive Jaundice. PhD thesis, University of Glasgow.

Abstract

Owing to the high morbidity and mortality associated with laparotomy on patients with obstructive jaundice (Vellacott and Powell, 1979) and the short life expectance of the patients with malignant obstruction (Sarr and Cameron, 1982; Ubhi & Doran, 1986), there has been a recent swing in the management of patients with malignant biliary obstruction towards stenting the biliary system endoscopically or percutaneously rather than undertaking surgery (Bornman et al. 1986, Speer et al. 1987). Most of these patients underging stenting will not have surgical or histo-pathological confirmation of their disease. Therefore, it is essential to know the accuracy of radiological and imaging investigations, so that one can avoid the pitfall of failing to offer surgery to patients with curable disease. On the other hand, if radiology was sufficiently reliable one could avoid unnecessary laparotomy in patients with unresectable malignant obstruction. Furthermore, the precise diagnosis of the condition seems very important in determining the prognosis and the correct management (Ferrucci et al. 1983). STUDY I The work commenced with a retospective appraisal of the diagnostic value, usefulness and complications of percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangiopancreatography (ERCP) and ultrasonography of the upper abdomen (US) in 112 patients with obstructive jaundice. This was followed by a prospective evaluation of another 83 patients from the same department. US was considered satisfactory by the radiologist undertaking the procedure in 82% of the attempted scans. The main cause (87%) for unsatisfactory US scans was excessive bowel gas. PTC and ERCP were successful in outlining the biliary system in 96% (131/137) and 80% (72/90) of cases respectively. US and diagnostic ERCP were not associated with any complication. However, therapeutic ERCP was associated with a 19% (10/52) incidence of major complications including five deaths; these figures are comparable with those reported recently in other studies with regard to the palliative biliary stenting (Speer et al. 1987). The use of endoscopic sphincterotomy in young patients with choledocholithiasis who is not considered a high-risk candidate for surgery therefore is not recommended. On the other hand, PTC was associated with a 6.7% (9/135) major complication rate; this included three deaths, three cases of septicaemia, two cases of severe and repeated attacks of cholangitis, and one symptomatic bile leakage which precipitated an emergency laparotomy. There were no statistically significant differences in the maximum diameters of the common bile duct, common hepatic duct, gall-bladder and intrahepatic ducts in patients who developed complications compared to those who did not following PTC. Furthermore, there were no statistically significant differences regarding the incidence of complications in patients who had PTC alone and those who had PTC combined with percutaneous transhepatic biliary drainage (PTD). The overall diagnostic accuracy of the successful procedures as based on the original interpretation of the results were 78% for PTC, 84% for ERCP, and 50% for US. The figures are comparable with the results of similar studies (Gibbons et al. 1983; Gregg & McDonald, 1979; Matzen et al. 1982; Pedersen et al. 1985). However, the essential nature of the investigations in determining the management was for the first time considered in this study. (Abstract shortened by ProQuest.).

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Keywords: Medicine, Medical imaging
• Date of Award: 1988
• Depositing User: Enlighten Team
• Unique ID: glathesis:1988-77796
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 14 Jan 2020 11:53
• Last Modified: 14 Jan 2020 11:53
• URI: https://theses.gla.ac.uk/id/eprint/77796