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31 - Extrahepatic Biliary Cancer/Biliary Drainage
- from PART III - ORGAN-SPECIFIC CANCERS
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- By Tarun Sabharwal, Consultant Radiologist, Department of Radiology St. Thomas' Hospital London, UK, Manpreet Singh Gulati, Consultant Radiologist Queen Elizabeth Hospital Honorary, Foundation Trust London, UK, Andy Adam, Professor Department of Radiology, St. Thomas' Hospital London, UK
- Edited by Jean-François H. Geschwind, The Johns Hopkins University School of Medicine, Michael C. Soulen, University of Pennsylvania School of Medicine
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- Book:
- Interventional Oncology
- Published online:
- 18 May 2010
- Print publication:
- 15 September 2008, pp 358-376
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- Chapter
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Summary
In the early 1970s, Molnar and Stockum introduced nonsurgical biliary intervention in the form of percutaneous transhepatic biliary drainage (PTBD) (1). Percutaneous transhepatic cholangiography (PTC) had been performed for several years prior to this, but therapeutic biliary interventions had been outside the radiologists' domain. In the past 30 years, improved diagnostic imaging techniques and significant developments in interventional radiology and experience gained by clinical trials have revolutionized and clearly defined the role of percutaneous biliary interventions.
The role of PTC has progressively diminished in the face of noninvasive imaging techniques such as ultrasonography (US), three-dimensional (3D) computer tomography and magnetic resonance cholangiography (MRC). Endoscopic retrograde cholangiography has further reduced its diagnostic role in the recent years. PTC is now reserved only for problematic cases and as an evaluation immediately prior to percutaneous intervention.
PTBD, which was initially proposed as a routine preoperative measure for those with severe obstructive jaundice, is now more of a palliative procedure in patients with inoperable malignant obstruction. This has been brought about by improved preoperative patient preparation, good antibiotic therapy, improved surgical techniques and easy availability of endoscopic biliary drainage expertise. One of the most important recent advances has been the introduction of self-expanding metallic stents for use in malignant obstructions.
In this chapter, we discuss all of the aforementioned percutaneous interventional radiological techniques, their indications and the other issues involved.
9 - Role of Stents in the Management of Esophageal Cancer
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- By Tarun Sabharwal, Consultant, Interventional Radiologist and Honorary Senior Lecturer, Guy's and St. Thomas' Foundation Trust, Department of Radiology, St. Thomas' Hospital, London, UK, Andreas Adam, Professor, Interventional Radiology, Guy's, King's and St. Thomas' School of Medicine, London, UK
- Edited by Sheila C. Rankin
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- Book:
- Carcinoma of the Esophagus
- Published online:
- 08 August 2009
- Print publication:
- 06 December 2007, pp 134-144
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- Chapter
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Summary
Introduction
Esophageal cancer is the sixth leading cause of death from malignant disease worldwide. Patients may have no symptoms until the diameter of the esophageal lumen has been reduced by 50%, resulting in late presentation and poor prognosis. Esophageal neoplasms are associated with a poor outcome, with an overall 5-year survival rate of less than 10%. Fewer than 50% of patients are suitable for resection at presentation, and palliation is the best option for those with irresectable lesions.
Esophageal stents for palliation
The aims of palliative treatment are maintenance of oral intake, minimizing hospital stay, relief of pain, elimination of reflux and regurgitation, and prevention of aspiration. Current methods of palliation include thermal ablation, photodynamic therapy, radiotherapy, chemotherapy, chemical injection therapy, argon beam or bipolar electrocoagulation therapy, enteral feeding (nasogastric tube/percutaneous endoscopic gastrostomy), and intubation with self-expanding metal stents (SEMS) or semirigid prosthetic tubes.
Endoluminal esophageal prostheses have been in use for over a century. A variety of tubes inserted using pulsion or traction have been described. Leroy d'Etiolles made the earliest device in 1845 of decalcified ivory, followed by Charters J. Symonds who introduced the first metal esophageal prosthesis in 1885. Esophageal stenting using SEMS is the commonest modern means of palliation and is associated with high success rates and relatively few complications.