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Malignant biliary obstruction: Percutaneous transhepatic drainage and stenting

Malignant biliary obstruction: Percutaneous transhepatic drainage and stenting - What it is

​Cancer arising originally from the liver or spread to the liver from cancer elsewhere can cause obstruction to the normal flow of digestive juice (bile) from liver into the bowel. Usually, patients are known to have a cancer or occasionally present to their doctor with symptoms related to this for the first time.

Malignant biliary obstruction: Percutaneous transhepatic drainage and stenting - Symptoms

​Usually, patients may present with worsening jaundice (yellowing of the white part of the eyes), itching, dark urine and pale/white stools and also sometimes with abdominal pain. The symptoms will worsen and impact on the quality of life if the obstruction is not relieved.

Malignant biliary obstruction: Percutaneous transhepatic drainage and stenting - How to prevent?

Consume alcohol only in moderation and avoid alcohol abuse. 
Ensure you are up to date on your recommended vaccinations (e.g. Hepatitis B vaccination). 
The common causes of liver cancer are alcohol abuse and viral liver infections (hepatitis B and C) which are transmitted through sexual contact and blood stream.

Regular medical screening is helpful in the early detection and treatment of cancers. 

Malignant biliary obstruction: Percutaneous transhepatic drainage and stenting - Causes and Risk Factors

Damage to the liver such as from excessive alcohol consumption, or viral infections (such as Hepatitis B or C virus) can lead to the formation of liver cancer cells, which subsequently grow and spread within the liver.
Blood continually passes through the liver to become detoxified. Some cancers allow cells from other organs (such as the colon or rectum) to travel through the blood stream, and these cancer cells can take root in the liver and form small colonies. 

Malignant biliary obstruction: Percutaneous transhepatic drainage and stenting - Diagnosis

​If you or family members have advanced cancer of the liver, which is causing worsening jaundice, this may be treatable with stenting the bile tube/duct which can reduce the yellowish skin discoloration and intractable itching. This may significantly improve the quality of life. Please ask your doctor for relevant information.  

Malignant biliary obstruction: Percutaneous transhepatic drainage and stenting - Treatments

 

Percutaneous transhepatic biliary drainage and stenting refers to procedures performed to provide relief from tumor obstruction of the bile duct under image/X-ray guidance, without the need for open surgery or endoscopy. 

Under local anaesthesia and sedation, in a sterile environment, a very thin needle is advanced through the skin into the liver using Ultrasound and/or X-ray guidance. The bile duct narrowed/obstructed is crossed is with the use of medical devices and a drainage tube is inserted to drain the bile and relieve obstruction. 

Billiary
 

Subsequently, in patients with advanced/end-stage cancer, a metallic stent is inserted to keep the narrowing open for a longer duration. After the stent insertion, the drainage tube/catheter can be removed so that nothing is hanging outside your body. 

 Billiary

 

 


Malignant biliary obstruction: Percutaneous transhepatic drainage and stenting - Preparing for surgery

Your doctor and the staff caring for you will give instruction you as to when to fast the day before the procedure. If you are on certain medications which thin your blood e.g. Aspirin, Clopidogrel (Plavix), Warfarin, Low molecular weight heparin (Clexane), Rivaroxaban etc, you may be asked to stop these medications at the appropriate intervals before the procedure. In some situations, you may be asked to undergo additional tests, such as biopsy or brushing of the tumor before proceeding with stenting of the tumor. 

Malignant biliary obstruction: Percutaneous transhepatic drainage and stenting - Post-surgery care

Malignant biliary obstruction: Percutaneous transhepatic drainage and stenting - Other Information

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