Title: Clinical Profile of Extrahepatic Biliary Obstruction Cases Undergoing ERCP at an Indian Tertiary Care Centre
Authors: Shalini Upadhyay, Rajat Bhargava, Akash Rajender, Gopal Singh, Subhash Nepalia
DOI: https://dx.doi.org/10.18535/jmscr/v7i5.141
Abstract
Background and Aims: Extrahepatic biliary obstruction (EHBO) is a common condition seen by gastroenterologist. We studied demographic, clinical, laboratory and endoscopic features of patients with EHBO undergoing Endoscopic retrograde cholangiopancreatography (ERCP) at our centre.
Material and Methods: We retrospectively analyzed our two year (2017-2018) data of ERCP. Diagnosis was based on laboratory parameters with imaging and cytological confirmation wherever possible.
Results: Our study comprises of 287 patients, among them 65.6% were female. Among them stones were found in 195 (67.9%) cases and strictures in 76 (26.4%) cases while other cases consisted of Sphincter of Oddi dysfunctioning (SOD), Bile duct leak, Hydatid cyst in 16 (5.5%) cases. Among the strictures, malignant strictures were seen in 52 (68.5%) cases, where most common cause was Carcinoma Gall bladder (GB) in 21 (40.4%) cases followed by Periampullary Carcinoma in 18 (34.6%), Carcinoma Head of Pancreas in 7 (13.5%), Cholangiocarcinoma in 6 (11.5%) respectively. Remaining 24 (31.5%) had either benign biliary strictures or indeterminate strictures. Presenting symptoms were cholestatic jaundice in 147 (51.2%) cases, in patients with stones it was 66 (33.8%) and in malignant strictures it was present in 50 (96.1%) cases. Other symptoms were pain, fever and pruritus. Cholangitis was seen in 58 (20.2%) cases. On investigating, 178 (62%) cases were found to have anemia (Hb <12), 70 (24.3%) cases had leucocytosis (TLC>12000), 21 (7.3%) cases had thrombocytopenia. During ERCP, Periampullary diverticulae was present in 27 (9.4%) cases. Among cases of choledocolithiasis, 105(53.8%) cases had single stone while 90 (46.2%) cases had multiple stones. About 129 (66.1%) cases had stone size <1cm while 66(33.9%) cases had stone size >1cm. After ERCP, 138(70.7%) cases had complete clearance, 18(9.3%) cases had partial clearance, 39(20%) cases had no clearance and stent was placed. Among patients with malignant stricture, 42(80.8%) had block below hilum (Type 1), 9(17.3%) had hilar block (Type 2), 1(1.9%) case had complex anatomy of block (Type 3).
Conclusions: Earlier in all Indian studies, malignancy was found to be the most common cause of EHBO. We have analyzed the cases undergoing ERCP, Common bile duct (CBD) stones were found to be most common cause followed by malignancy stricture. GB Carcinoma was most common cause of malignant EHBO.
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