The unresectable pancreatic head tumors develop obstructive jaundice and cholestasis during follow-up. Cholestasis is associated with complications and treatment options are endoscopic stenting (ES) and biliary bypass surgery (BBS).
The aim of the current study was to compare the safety and efficacy of biliary bypass surgery (BBS) and endoscopic stenting (ES) for cholestasis in advanced pancreas cancer.
This is a retrospective cohort of patients with cholestasis and unresectable or metastatic pancreas cancer, treated with BBS or ES. Short and long-term outcomes were evaluated. We considered the need for hospital readmission due to biliary complications as treatment failure.
A total of 93 patients (BBS=43; ES=50) were included in the study. BBS was associated with a higher demand for postoperative intensive care (37 vs.10%; p=0.002, p<0.050), longer intensive care unit stay (1.44 standard deviation±2.47 vs. 0.66±2.24 days; p=0.004, p<0.050), and longer length of hospital stay (7.95±2.99 vs. 4.29±5.50 days; p<0.001, p<0.050). BBS had a higher risk for procedure-related complications (23 vs. 8%; p=0.049, p<0.050). There was no difference in overall survival between BBS and ES (p=0.089, p>0.050). ES was independently associated with a higher risk for treatment failure than BBS on multivariate analysis (hazard ratio 3.97; p=0.009, p<0.050).
BBS is associated with longer efficacy than ES for treating cholestasis in advanced pancreatic cancer. However, the BBS is associated with prolonged intensive care unit and hospital stays and higher demand for intensive care.
Acute hepatitis B (HBV) infection is asymptomatic, subclinical illness in approximately two thirds of cases and diagnosis is made only through serologic testing7. Clinical evidence of hepatitis; jaundice and occasionally acute liver failure develops in rest one third of patients with acute HBV infection7. Cholestatic hepatitis is one of very rare manifestations of acute HBV infection, but when develop it leads to prolonged hospital stay and increased medical expenses5. Rapid improvement of the clinical symptoms and signs have been reported in patients with cholestatic hepatitis A (HAV) after use of corticosteroid6. We here report a case of cholestatic hepatitis due to acute HBV infection and rapid improvement of symptoms with oral prednisolone.
A 56-year old female patient presented with complaints of progressively increasing jaundice and intense pruritus that disturbed sleep for 12 weeks duration. She had been evaluated at a local hospital and diagnosed to have acute viral hepatitis due to hepatitis B virus infection (HBV) on the basis of raised liver enzymes and serological markers (Table 1).
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