Progress and prospect of reducing jaundice tretment in elderly patients with malignant obstructive jaundice_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

JIN Yajie ,  SUN Haijun

Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, P. R. China;

Corresponding author：

SUN Haijun, Email: 15945777708@163.com

Keywords：

malignant obstructive jaundice; percutaneous transhepatic biliary drainage; endoscopic biliary stent implantation; elderly patient

DOI：

10.7507/1007-9424.202011016

Video：

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Objective To summarize the various treatment methods for reducing jaundice in the elderly patients with malignant obstructive jaundice (MOJ), and provide reference for the treatment of elderly MOJ.Method Using “malignant obstructive jaundice” as the Chinese keyword and the English keyword, a computer search of the literatures on the treatment of elderly MOJ patients was conducted and reviewed.Results The treatment methods of reducing jaundice in elderly MOJ included radical surgery, cholangiojejunostomy, endoscopic ultrasound-guided biliary drainage, endoscopic biliary stent implantation, percutaneous transhepatic biliary drainage and stent implantation. Radical surgery was the most effective, but it was traumatic and had many complications for elderly patients. Cholangiojejunostomy was effective and suitable for elderly patients who cannot tolerate major surgery. Endoscopic ultrasound-guided biliary drainage was less traumatic to elderly patients, but technical difficulty. Endoscopic biliary stent implantation was currently the first-line choice for the treatment of elderly patients with advanced MOJ. Percutaneous transhepatic biliary drainage and stent implantation were suitable for elderly and frail patients with high obstruction.Conclusion The treatment of elderly MOJ needs to be individualized and regionalized, and appropriate treatment methods should be selected according to the patient’s condition and the medical level of the medical center.

Citation： JIN Yajie, SUN Haijun. Progress and prospect of reducing jaundice tretment in elderly patients with malignant obstructive jaundice. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(9): 1249-1253. doi: 10.7507/1007-9424.202011016 Copy

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2.	Rizzo A, Frega G, Ricci AD, et al. Anti-EGFR monoclonal antibodies in advanced biliary tract cancer: a systematic review and meta-analysis. In Vivo, 2020, 34(2): 479-488.
3.	He X, Song M, Qu J, et al. Basic and translational aging research in China: present and future. Protein Cell, 2019, 10(7): 476-484.
4.	周迪, 杨勇, 汤朝晖, 等. 肝门部胆管癌日本诊治体系的历史沿革、现状和瓶颈. 中华外科杂志, 2019, 57(1): 6-9.
5.	Nathan H, Aloia TA, Vauthey JN, et al. A proposed staging system for intrahepatic cholangiocarcinoma. Ann Surg Oncol, 2009, 16(1): 14-22.
6.	Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the international study group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery, 2017, 161(3): 584-591.
7.	赵玉沛. 胰腺术后外科常见并发症诊治及预防的专家共识(2017). 协和医学杂志, 2017, 8(2): 139-146.
8.	Yuan F, Essaji Y, Belley-Cote EP, et al. Postoperative complications in elderly patients following pancreaticoduodenectomy lead to increased postoperative mortality and costs. A retrospective cohort study. Int J Surg, 2018, 60: 204-209.
9.	Cesaretti M, Bifulco L, Costi R, et al. Pancreatic resection in the era of laparoscopy: State of Art. A systematic review. Int J Surg, 2017, 44: 309-316.
10.	Birgin E, Téoule P, Galata C, et al. Cholangitis following biliary-enteric anastomosis: A systematic review and meta-analysis. Pancreatology, 2020, 20(4): 736-745.
11.	Sandhu J, Swersky A, Salsamendi J, et al. Utilization of a modified Roux-en-Y anastomosis as an access point for percutaneous transjejunal cholangioplasty of recurrent biliary strictures. Cardiovasc Intervent Radiol, 2019, 42(12): 1745-1750.
12.	Yeo MK, Kim KH, Lee YM, et al. The usefulness of adding p53 immunocytochemistry to bile drainage cytology for the diagnosis of malignant biliary strictures. Diagn Cytopathol, 2017, 45(7): 592-597.
13.	Artifon EL, Otoch JP, Tchekmedyian AJ. A review on endoscopic palliation of obstructive jaundice before surgery. Rev Gastroenterol Peru, 2014, 34(3): 225-228.
14.	Sarkodie BD, Botwe BO, Brakohiapa EKK. Percutaneous transhepatic biliary stent placement in the palliative management of malignant obstructive jaundice: initial experience in a tertiary center in Ghana. Pan Afr Med J, 2020, 37: 96.
15.	Higuchi R, Yazawa T, Uemura S, et al. ENBD is associated with decreased tumor dissemination compared to ptbd in perihilar cholangiocarcinoma. J Gastrointest Surg, 2017, 21(9): 1506-1514.
16.	Duan F, Cui L, Bai Y, et al. Comparison of efficacy and complications of endoscopic and percutaneous biliary drainage in malignant obstructive jaundice: a systematic review and meta-analysis. Cancer Imaging, 2017, 17(1): 27.
17.	Dhir V, Itoi T, Khashab MA, et al. Multicenter comparative evaluation of endoscopic placement of expandable metal stents for malignant distal common bile duct obstruction by ERCP or EUS-guided approach. Gastrointest Endosc, 2015, 81(4): 913-923.
18.	邹茂贤, 唐兴奎, 何金花, 等. 恶性胆道梗阻患者行 ERCP 支架置入治疗的效果及其肝功能指标的变化. 检验医学与临床, 2018, 15(13): 1948-1951.
19.	Easler JJ, Sherman S, Coté GA. Optimizing palliation of malignant hilar strictures by the use of endobiliary stents. Gastrointest Endosc, 2017, 86(5): 828-830.
20.	Canakis A, Baron TH. Relief of biliary obstruction: choosing between endoscopic ultrasound and endoscopic retrograde cholangiopancreatography. BMJ Open Gastroenterol, 2020, 7(1): e000428.
21.	Hara K, Yamao K, Mizuno N, et al. Endoscopic ultrasonography-guided biliary drainage: Who, when, which, and how? World J Gastroenterol, 2016, 22(3): 1297-1303.
22.	Wang K, Zhu J, Xing L, et al. Assessment of efficacy and safety of EUS-guided biliary drainage: a systematic review. Gastrointest Endosc, 2016, 83(6): 1218-1227.
23.	Paik WH, Lee TH, Park DH, et al. EUS-guided biliary drainage versus ercp for the primary palliation of malignant biliary obstruction: a multicenter randomized clinical trial. Am J Gastroenterol, 2018, 113(7): 987-997.
24.	Baars JE, Kaffes AJ, Saxena P. EUS-guided biliary drainage: A comprehensive review of the literature. Endosc Ultrasound, 2018, 7(1): 4-9.
25.	Alvarez-Sánchez MV, Luna OB, Oria I, et al. Feasibility and safety of endoscopic ultrasound-guided biliary drainage (EUS-BD) for malignant biliary obstruction associated with ascites: results of a pilot study. J Gastrointest Surg, 2018, 22(7): 1213-1220.
26.	Paik WH, Park DH. Outcomes and limitations: EUS-guided hepaticogastrostomy. Endosc Ultrasound, 2019, 8(Suppl 1): S44-S49.
27.	Leung Ki EL, Napoleon B. Endoscopic ultrasound-guided biliary drainage: A change in paradigm? World J Gastrointest Endosc, 2019, 11(5): 345-353.
28.	Park JK, Woo YS, Noh DH, et al. Efficacy of EUS-guided and ERCP-guided biliary drainage for malignant biliary obstruction: prospective randomized controlled study. Gastrointest Endosc, 2018, 88(2): 277-282.
29.	Kakked G, Salameh H, Cheesman AR, et al. Primary EUS-guided biliary drainage versus ERCP drainage for the management of malignant biliary obstruction: A systematic review and meta-analysis. Endosc Ultrasound, 2020, 9(5): 298-307.
30.	Sharaiha RZ, Khan MA, Kamal F, et al. Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails: a systematic review and meta-analysis. Gastrointest Endosc, 2017, 85(5): 904-914.
31.	叶诚, 苗龙, 王正峰, 等. EUS-BD 与 PTBD 治疗恶性梗阻性黄疸疗效的 meta 分析. 中国普外基础与临床杂志, 2019, 26(2): 192-199.
32.	Laleman W, van der Merwe S, Verbeke L, et al. A new intraductal radiofrequency ablation device for inoperable biliopancreatic tumors complicated by obstructive jaundice: the IGNITE-1 study. Endoscopy, 2017, 49(10): 977-982.
33.	Yang J, Wang J, Zhou H, et al. Efficacy and safety of endoscopic radiofrequency ablation for unresectable extrahepatic cholan-giocarcinoma: a randomized trial. Endoscopy, 2018, 50(8): 751-760.
34.	Sofi AA, Khan MA, Das A, et al. Radiofrequency ablation combined with biliary stent placement versus stent placement alone for malignant biliary strictures: a systematic review and meta-analysis. Gastrointest Endosc, 2018, 87(4): 944-951.
35.	Kadayifci A, Atar M, Forcione DG, et al. Radiofrequency ablation for the management of occluded biliary metal stents. Endoscopy, 2016, 48(12): 1096-1101.
36.	Ma J, Luo J, Gu J, et al. Malignant obstructive jaundice treated with intraluminal placement of Iodine-125 seed strands and metal stents: An analysis of long-term outcomes and prognostic features. Brachytherapy, 2018, 17(4): 689-695.
37.	Zhu HD, Guo JH, Huang M, et al. Irradiation stents vs. conventional metal stents for unresectable malignant biliary obstruction: A multicenter trial. J Hepatol, 2018, 68(5): 970-977.

1. Rizzo A, Ricci AD, Frega G, et al. How to choose between percutaneous transhepatic and endoscopic biliary drainage in malignant obstructive jaundice: an updated systematic review and meta-analysis. In Vivo, 2020, 34(4): 1701-1714.
2. Rizzo A, Frega G, Ricci AD, et al. Anti-EGFR monoclonal antibodies in advanced biliary tract cancer: a systematic review and meta-analysis. In Vivo, 2020, 34(2): 479-488.
3. He X, Song M, Qu J, et al. Basic and translational aging research in China: present and future. Protein Cell, 2019, 10(7): 476-484.
4. 周迪, 杨勇, 汤朝晖, 等. 肝门部胆管癌日本诊治体系的历史沿革、现状和瓶颈. 中华外科杂志, 2019, 57(1): 6-9.
5. Nathan H, Aloia TA, Vauthey JN, et al. A proposed staging system for intrahepatic cholangiocarcinoma. Ann Surg Oncol, 2009, 16(1): 14-22.
6. Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the international study group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery, 2017, 161(3): 584-591.
7. 赵玉沛. 胰腺术后外科常见并发症诊治及预防的专家共识(2017). 协和医学杂志, 2017, 8(2): 139-146.
8. Yuan F, Essaji Y, Belley-Cote EP, et al. Postoperative complications in elderly patients following pancreaticoduodenectomy lead to increased postoperative mortality and costs. A retrospective cohort study. Int J Surg, 2018, 60: 204-209.
9. Cesaretti M, Bifulco L, Costi R, et al. Pancreatic resection in the era of laparoscopy: State of Art. A systematic review. Int J Surg, 2017, 44: 309-316.
10. Birgin E, Téoule P, Galata C, et al. Cholangitis following biliary-enteric anastomosis: A systematic review and meta-analysis. Pancreatology, 2020, 20(4): 736-745.
11. Sandhu J, Swersky A, Salsamendi J, et al. Utilization of a modified Roux-en-Y anastomosis as an access point for percutaneous transjejunal cholangioplasty of recurrent biliary strictures. Cardiovasc Intervent Radiol, 2019, 42(12): 1745-1750.
12. Yeo MK, Kim KH, Lee YM, et al. The usefulness of adding p53 immunocytochemistry to bile drainage cytology for the diagnosis of malignant biliary strictures. Diagn Cytopathol, 2017, 45(7): 592-597.
13. Artifon EL, Otoch JP, Tchekmedyian AJ. A review on endoscopic palliation of obstructive jaundice before surgery. Rev Gastroenterol Peru, 2014, 34(3): 225-228.
14. Sarkodie BD, Botwe BO, Brakohiapa EKK. Percutaneous transhepatic biliary stent placement in the palliative management of malignant obstructive jaundice: initial experience in a tertiary center in Ghana. Pan Afr Med J, 2020, 37: 96.
15. Higuchi R, Yazawa T, Uemura S, et al. ENBD is associated with decreased tumor dissemination compared to ptbd in perihilar cholangiocarcinoma. J Gastrointest Surg, 2017, 21(9): 1506-1514.
16. Duan F, Cui L, Bai Y, et al. Comparison of efficacy and complications of endoscopic and percutaneous biliary drainage in malignant obstructive jaundice: a systematic review and meta-analysis. Cancer Imaging, 2017, 17(1): 27.
17. Dhir V, Itoi T, Khashab MA, et al. Multicenter comparative evaluation of endoscopic placement of expandable metal stents for malignant distal common bile duct obstruction by ERCP or EUS-guided approach. Gastrointest Endosc, 2015, 81(4): 913-923.
18. 邹茂贤, 唐兴奎, 何金花, 等. 恶性胆道梗阻患者行 ERCP 支架置入治疗的效果及其肝功能指标的变化. 检验医学与临床, 2018, 15(13): 1948-1951.
19. Easler JJ, Sherman S, Coté GA. Optimizing palliation of malignant hilar strictures by the use of endobiliary stents. Gastrointest Endosc, 2017, 86(5): 828-830.
20. Canakis A, Baron TH. Relief of biliary obstruction: choosing between endoscopic ultrasound and endoscopic retrograde cholangiopancreatography. BMJ Open Gastroenterol, 2020, 7(1): e000428.
21. Hara K, Yamao K, Mizuno N, et al. Endoscopic ultrasonography-guided biliary drainage: Who, when, which, and how? World J Gastroenterol, 2016, 22(3): 1297-1303.
22. Wang K, Zhu J, Xing L, et al. Assessment of efficacy and safety of EUS-guided biliary drainage: a systematic review. Gastrointest Endosc, 2016, 83(6): 1218-1227.
23. Paik WH, Lee TH, Park DH, et al. EUS-guided biliary drainage versus ercp for the primary palliation of malignant biliary obstruction: a multicenter randomized clinical trial. Am J Gastroenterol, 2018, 113(7): 987-997.
24. Baars JE, Kaffes AJ, Saxena P. EUS-guided biliary drainage: A comprehensive review of the literature. Endosc Ultrasound, 2018, 7(1): 4-9.
25. Alvarez-Sánchez MV, Luna OB, Oria I, et al. Feasibility and safety of endoscopic ultrasound-guided biliary drainage (EUS-BD) for malignant biliary obstruction associated with ascites: results of a pilot study. J Gastrointest Surg, 2018, 22(7): 1213-1220.
26. Paik WH, Park DH. Outcomes and limitations: EUS-guided hepaticogastrostomy. Endosc Ultrasound, 2019, 8(Suppl 1): S44-S49.
27. Leung Ki EL, Napoleon B. Endoscopic ultrasound-guided biliary drainage: A change in paradigm? World J Gastrointest Endosc, 2019, 11(5): 345-353.
28. Park JK, Woo YS, Noh DH, et al. Efficacy of EUS-guided and ERCP-guided biliary drainage for malignant biliary obstruction: prospective randomized controlled study. Gastrointest Endosc, 2018, 88(2): 277-282.
29. Kakked G, Salameh H, Cheesman AR, et al. Primary EUS-guided biliary drainage versus ERCP drainage for the management of malignant biliary obstruction: A systematic review and meta-analysis. Endosc Ultrasound, 2020, 9(5): 298-307.
30. Sharaiha RZ, Khan MA, Kamal F, et al. Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails: a systematic review and meta-analysis. Gastrointest Endosc, 2017, 85(5): 904-914.
31. 叶诚, 苗龙, 王正峰, 等. EUS-BD 与 PTBD 治疗恶性梗阻性黄疸疗效的 meta 分析. 中国普外基础与临床杂志, 2019, 26(2): 192-199.
32. Laleman W, van der Merwe S, Verbeke L, et al. A new intraductal radiofrequency ablation device for inoperable biliopancreatic tumors complicated by obstructive jaundice: the IGNITE-1 study. Endoscopy, 2017, 49(10): 977-982.
33. Yang J, Wang J, Zhou H, et al. Efficacy and safety of endoscopic radiofrequency ablation for unresectable extrahepatic cholan-giocarcinoma: a randomized trial. Endoscopy, 2018, 50(8): 751-760.
34. Sofi AA, Khan MA, Das A, et al. Radiofrequency ablation combined with biliary stent placement versus stent placement alone for malignant biliary strictures: a systematic review and meta-analysis. Gastrointest Endosc, 2018, 87(4): 944-951.
35. Kadayifci A, Atar M, Forcione DG, et al. Radiofrequency ablation for the management of occluded biliary metal stents. Endoscopy, 2016, 48(12): 1096-1101.
36. Ma J, Luo J, Gu J, et al. Malignant obstructive jaundice treated with intraluminal placement of Iodine-125 seed strands and metal stents: An analysis of long-term outcomes and prognostic features. Brachytherapy, 2018, 17(4): 689-695.
37. Zhu HD, Guo JH, Huang M, et al. Irradiation stents vs. conventional metal stents for unresectable malignant biliary obstruction: A multicenter trial. J Hepatol, 2018, 68(5): 970-977.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Progress and prospect of reducing jaundice tretment in elderly patients with malignant obstructive jaundice

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