Cholangitis in biliary tract malignancies - facts and experience of diagnosing and treatment.

Konference: 2009 XXXIII. Brněnské onkologické dny a XXIII. Konference pro sestry a laboranty

Kategorie: Gastrointestinální nádory

Téma: XIX. Primární a sekundární nádory jater

Číslo abstraktu: 177p

Autoři: MUDr. Štěpán Tuček, PhD.; MUDr. Jiří Tomášek, Ph.D.; MUDr. Igor Kiss, Ph.D.; MUDr. Jana Halámková, Ph.D.; MUDr. Tomáš Andrašina

Summary

Acute cholangitis is a result of bacterial contamination and overgrowth within an obstructed biliary system. Most common cause (80% in Western world) is a stone obstructing the common bile duet. Other causes include parasitic infestations, benign postoperative bile duet strictures, papillary stenosis, chronic pancreatitis, sclerosing cholangitis, iatrogenic causes during diagnosing or treating procedures and of course malignancies.

In patients with terminal hepatobiliary cancer, cholangitis is one of the possible causes of death. Also during diagnosing and treatment process of these cancer patients, cholangitis is a frequent threat. At any stage of the disease, cholangitis can be directly life threatening and as such requires urgent biliary decompression in patients who fail to respond to conservative treatment. Morbidity resulting from cholangitis represents a major issue in patients' quality of life. Also constantly inereasing economic burden comes forward.

Bacteria contaminating bile can range from common microflora of small intestine to polyresistant nosocomial pathogens. The latter ones can cause difficulties in successful therapy and can be of great significance to hospital epidemiology. There has been understandable shift in bacterial colonization due to evolution and wide use of broad spectrum antibiotics.

Nonsurgical therapy is nowadays most common treatment. It includes endoscopy and interventional radiology and has resulted in better clinical outcome in past decades, with lower mortality and morbidity. Use of antibiotics either in monotherapy or in combination should comply with reasonable and local antibiotic policy.

Treatment of cholangitis of patients with hepatobiliary malignancies has some special features. Especially patients with unresectable hepatobiliary cancer who undergo palliative treatment require considerate care with great respect to life expectancy, life quality and need to be very dosely involved in decision making.

We present these special features from our experience with 76 patients treated for cholangiocarcinoma, carcinoma of gallbladder and ampuloma.

Interdisciplinary and individual approach is needed for each of these patients. Thus management of these patients including cholangitis treatment can be far more effective in centres that meet requirements for special technical resources and skilled personnel.

Datum přednesení příspěvku: 16. 4. 2009