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- W2891552661 abstract "Background: Up to 80% of patients with periampullary malignancies present with obstructive jaundice. Additionally, up to 40% of them will have metastatic disease on presentation. The goal of therapy in these patients is to initiate systemic therapy without delay or complications. Herein we describe a complete endoscopic technique for diagnosing, staging, and palliating a periampullary malignancy. Methods: An 80-year-old female with multiple comorbidities presented with progressive nausea, vomiting, heartburn, and weight-loss. Her laboratoriy values were normal with the exception of an elevated CEA and CA 19-9. A computed tomography scan demonstrated biliary and gastric outlet obstruction at the level of a mass in the second portion of the duodenum with no evidence of distant disease or mesenteric vascular involvement. She was referred for an endoscopy with ultrasound (EUS). EUS demonstrated a suspicious lesion in the liver and biopsy confirmed malignant cells. Given the inability to render curative therapy, endoscopic biliary palliation was achieved via an EUS-guided choledochoduodenostomy with a self-expanding, lumen-apposing stent. Subsequently, an endoscopic gastrojejunostomy was created using another self-expanding, lumen-apposing stent by identifying a suitable loop of jejunum after instillation of methylene blue. Results: She tolerated oral intake the following day and began systemic chemotherapy within 2 weeks. At 3 months post-procedure, she had no biliary or gastric outlet obstruction. Conclusion: This technique can be used for patients with unresectable or metastatic disease who require palliation of gastric and/or biliary obstruction to expedite initiation of systemic chemotherapy. However, it requires close communication between gastroenterologists, surgeons, and oncologists to identify appropriate candidates and minimize the risk of complications." @default.
- W2891552661 created "2018-09-27" @default.
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- W2891552661 date "2018-03-01" @default.
- W2891552661 modified "2023-09-26" @default.
- W2891552661 title "Complete endoscopic diagnosis, staging, and palliation of periampullary malignancy" @default.
- W2891552661 doi "https://doi.org/10.1016/j.hpb.2018.02.641" @default.
- W2891552661 hasPublicationYear "2018" @default.
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