TY - JOUR
T1 - An argument against routine percutaneous biopsy, ERCP, or biliary stent placement in patients with clinically resectable periampullary masses
T2 - A surgical perspective
AU - Temudom, Thamrongroj
AU - Sarr, Michael G.
AU - Douglas, Michael G.
AU - Farnell, Michael B.
PY - 1995/10
Y1 - 1995/10
N2 - Improved resolution of computed tomography (CT) and ultrasonography allows us to visualize the proximal extent of biliary obstruction and the presence of a periampullary mass in most patients with malignant extrahepatic biliary obstruction. Our purpose in this report is to challenge the need for preoperative percutaneous biopsy, endoscopic retrograde cholangiopancreatography, or preoperative placement of a biliary endoprosthesis in the good-risk patient in whom the imaging procedure clearly defines a periampullary mass and the proximal extent (hepatic extent) of biliary obstruction. We recently managed three patients in whom one of these invasive procedures led to a complication that delayed,prevented, or complicated appropriate operative resection of a pancreatic neoplasm. Because a negative percutaneous biopsy, cholangiographic imaging of a dilated bile/pancreatic duct clearly seen on CT or ultrasonography, or short-term preoperative biliary decompression does not alter the decision for operative exploration and may cause complications, we argue against their use in the good-risk patient with both extrahepatic biliary ob-struction and a periampullary pancreatic mass well delineated on noninvasive imaging.
AB - Improved resolution of computed tomography (CT) and ultrasonography allows us to visualize the proximal extent of biliary obstruction and the presence of a periampullary mass in most patients with malignant extrahepatic biliary obstruction. Our purpose in this report is to challenge the need for preoperative percutaneous biopsy, endoscopic retrograde cholangiopancreatography, or preoperative placement of a biliary endoprosthesis in the good-risk patient in whom the imaging procedure clearly defines a periampullary mass and the proximal extent (hepatic extent) of biliary obstruction. We recently managed three patients in whom one of these invasive procedures led to a complication that delayed,prevented, or complicated appropriate operative resection of a pancreatic neoplasm. Because a negative percutaneous biopsy, cholangiographic imaging of a dilated bile/pancreatic duct clearly seen on CT or ultrasonography, or short-term preoperative biliary decompression does not alter the decision for operative exploration and may cause complications, we argue against their use in the good-risk patient with both extrahepatic biliary ob-struction and a periampullary pancreatic mass well delineated on noninvasive imaging.
KW - Biliary endoprosthesis
KW - Endoscopic retrograde cholangiopancreatography
KW - Obstructive jaundice
KW - Pancreatic cancer
KW - Periampullary cancer
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U2 - 10.1097/00006676-199510000-00011
DO - 10.1097/00006676-199510000-00011
M3 - Article
C2 - 8577683
AN - SCOPUS:0029125467
SN - 0885-3177
VL - 11
SP - 283
EP - 288
JO - Pancreas
JF - Pancreas
IS - 3
ER -