Malignant Obstructive Jaundice

Background

Clinical KeyMalignant Obstructive Jaundice (MOJ) is a common reason for obstruction of the biliary tract. According to the Journal of the National Comprehensive Cancer Network, primary biliary tract cancers account for 80,000 new cancer cases and 58,000 deaths per year in the US. Despite advances in diagnosis and treatment, the 5-year survival with the most likely malignancies, pancreatic and cholangiocarcinoma, remains at less than 5%.

Current Treatment

Treatment of the obstruction is typically done with Endoscopic Retrograde Cholangiogram (ERCP) and Endoscopic Ultrasound (EUS) is often accomplished in the same procedure. These tools can allow for sampling of the obstructing lesions and can also be used for assessment of disease spread and staging. Metal or plastic stents can be used to maintain biliary patency, and are a major intervention for more advanced disease. For some early diagnosed cancers surgery can be curative, for most cases, the disease is not diagnosed until it is already unresectable, and surgery is done for palliative reasons.

Focused Ultrasound

Focused ultrasound can be used to treat the tumor and also to help lessen the pain that can occur with the underlying cancer. For more on a specific indication (e.g. pancreatic cancer), please see that section of our website. In addition, surgeons will also request focused ultrasound treatment prior to the operation, as they believe that the surgical resection is accomplished more readily after focused ultrasound.

Clinical Trials

In a recent clinical trial, patients with MOJ that either had focused ultrasound treatment or were not treated with stents. Those receiving focused ultrasound had a significantly longer stent patency time (367+41 vs 257+35), and the patient survival time was also significantly increased (238 +31 vs 152+20). The authors conclude that focused ultrasound ablation is safe and easy in these patients and appears to extend stent patency time and survival compared to stent placement alone.

Notable Papers

Niu S1, Cheng L, Qiao Y, Fu YF, Cao C. Combined Stent Insertion and High-intensity Focused Ultrasound Ablation for Patients With Malignant Obstructive Jaundice. Surg Laparosc Endosc Percutan Tech. 2016 Oct 25.

Wang K, Zhu H, Meng Z, Chen Z, Lin J, Shen Y, Gao H. Safety evaluation of high-intensity focused ultrasound in patients with pancreatic cancer. Onkologie. 2013;36(3):88-92. doi: 10.1159/000348530.

 

     

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