CLINICO-ETIOLOGIC PROFILE OF PATIENTS UNDERGOING ERCP FOR OBSTRUCTIVE JAUNDICE SECONDARY TO MALIGNANCY.

Abstract

Background: Astudy describing the ERCPprole of the patients undergoing the procedure for malignancy related obstructive jaundice. Aim:To analyse the patients undergoing ERCPfor malignant etiology of obstructive jaundice and characterise the outcomes. Introduction: The etiology of obstructive jaundice can be delineated easily into malignancy vs benign etiology. Benign etiology is dominated by stone disease. Malignancy can be varying from periampullary carcinoma, carcinoma head of pancreas, duodenal tumours, cholangiocarcinoma and others. In this study we attempt to analyse the patient prole and outcomes undergoing the procedure at our centre. Methods: A retrospective observational study, conducted in the Department of Digestive Health and Diseases, Kilpauk Medical College, from September 2018 to July 1st, 2019. All the patients undergoing ERCP for obstructive jaundice with probable malignant etiology diagnosed basing imaging and histopathology modes were included. The demographics and the procedure events were recorded after having obtained the informed consent. Results: A total of 70 patients were included in the study. There was male predominance in the study with 48(74.2%) patients and females comprising 18(25.8%). Atotal of 10(14.2%) patients were below the age of 45yrs and 60(85.17%) were above 45 yrs. The predominant etiology for which patients underwent the procedure was cholangiocarcinoma(n= 34, 48.5%). Sixteen patients (22.8%) had periampullary growth, whereas 10(14.2%) had carcinoma head of pancreas, followed by 4 patients with carcinoma of the gall bladder. 24 (34.2%) patients needed a sphincterotomy, 42(60%) patients could be successfully cannulated. During cannulation 36(51%) could be cannulated with 3 or less attempts whereas rest needed >3. Amongst the cannulated patients a plastic stent was successfully placed. 18(25.7%) needed a dilator (SBDC) for successful deployment. A total of 14 patients developed complications of which 10(14.2%) patients developed bleeding during the procedure for which standard of care followed and 2 developed mild post ERCPpancreatitis which was duly managed. Conclusion:Although ERCPhas been established as standard of care for relieving jaundice with obstruction, technical difculties pertaining to the growth location and access for the same restrict the outcomes in many cases. Hence the availability of other modes including palliative surgery could also be offered in such subset of patients.