Clinical Observation On Malignant Obstructive Jaundice After ERCP Drainage

Objective To explore the effects of malignant obstructive jaundice after four different waysof endoscopic retrograde cholangiopancreatography(ERCP) drainage. Methods We collect78cases of malignant obstructive jaundice which enrolled in our hospital from January2008to June2013.None of them was suitable for radical resection or unwilling to do surgicaltreatment.75cases were successfully embedded with biliary stents and performed differentendoscopic drainage, including endoscopic nasal biliary drainage (ENBD)10cases,endoscopic retrograde biliary drainage (ERBD)32cases,endoscopic biliary metallicstent drainage(EBMSD)21cases and endoscopic stent implantation joint nasal biliarydrainage12cases. The white blood cell count,neutrophil percentage,Liver function andcommon bile duct diameter which measured by abdominal ultrasound of patients werecompared preoperative and postoperative of the week. Results3cases of78were failure toembed with biliary stents,75patients were successfully performed biliary drainage withERCP and their clinical symptoms were disappeared or significantly reduced after operationone week later. Compared with the levels of the total bilirubin, direct bilirubin, alanineaminotransferase(ALT),aspartate aminotransferase(AST), Alkaline phosphatase(ALP) andγ-Glutamyl transferase(GGT) before operation,the indexes decreased one week afteroperation (P<0.05),but no significant difference was found of the white blood cell count andneutrophil percentage compared with the preoperative,except in preoperative merger cases ofacute cholangitis.The common bile duct diameter which measured by abdominal ultrasoundof every group were reduced compared with the preoperative(P<0.05). but no significantdifference of the change of white blood cell count,neutrophil percentage,Liver function andcommon bile duct diameter was found among any two groups.Biliary stent occlusion occurredin1patient embedded with EBMSD after3months and the other one embedded withEBMSD occurred after5months,then they were cleaned up the bile mud and placed withplastic stents into previous stents.1patient with nasal biliary drainage20seize the opportunityof surgical treatment in the future,The other patients liver function returned to normal after1month of nose biliary drainage and received radical surgery.The total serum bilirubin wasincreased in8cases embedded with plastic stent after1～4weeks because the stents weredisplaced and blocked. The stents were replaced and metal stents replacement for five ofthem,dual plastic stents were placed in three of them. Conclusion Biliary drainage throughEPCP could effectively extinct jaundice,relieve symptoms and improved the life quality forpatients with unresectable biliary obstruction caused by malignant neoplasm.