Role of Intervention in Alleviating Symptoms of Patients with Obstructive Jaundice of Malignant Pathology; A Retrospective Study in Tertiary Care Hospital of Lahore

Muhammad Irfan Fazal; Syeda Aliza Zahra Bokhari; Maha Naseem; Huma Tariq; Syeda Mahum Zahra Bokhari; Muhammad Usman Fazal

doi:10.70302/jpsim.v4i4.2361

Original Research

Role of Intervention in Alleviating Symptoms of Patients with Obstructive Jaundice of Malignant Pathology; A Retrospective Study in Tertiary Care Hospital of Lahore

Muhammad Irfan Fazal

Mayo Hospital Lahore

Syeda Aliza Zahra Bokhari

Mayo Hospital Lahore

Maha Naseem

Mayo Hospital Lahore

Huma Tariq

Mayo Hospital Lahore

Syeda Mahum Zahra Bokhari

Mayo Hospital Lahore

Muhammad Usman Fazal

Mayo Hospital Lahore

✉ Correspondence: Syeda Aliza Zahra Bokhari Email: drsyedaalizazahra@gmail.com

DOI https://doi.org/10.70302/jpsim.v4i4.2361

Volume: 4, Issue 4 Pages: 302–305 Published: 29 Nov 2023

Received: 31 Jul 2023 Accepted: 28 Aug 2023 Published Online: 29 Nov 2023

Abstract

Objective

to assess the role of intervention and MDT in alleviating symptoms of patients with jaundice of malignant obstructive pathology so the ratio of mortality and morbidity can be reduced.

Methodology

It is a retrospective study consisting of 62 patients having obstructive jaundice due to malignant pathology who were presented during January 2015 to January 2023 were studied. Patients were investigated, diagnosed and staged. Their operability and resectibility were assessed according to NCCN guidelines.

Results

Among 62 patients 61% were females while 39% males. Most effected age group was 40-53 years. Mostly obstructive jaundice was reported due to Carcinoma of head of pancreas 56% and second most common pathology was periampullary. Interventions done to relieve symptoms include Whipple procedure (52%), double bypass (23%), ERCP/PTBD (8%), and DP with splenectomy (3%). The outcome of these interventions shows 58% of patients were alive while 24% of pathology recurred.

Conclusion

Whipples’ procedure has encouraging results in decreasing the death rate among patients with malignant obstructive jaundice. TThe most common cause of malignant obstructive jaundice is the carcinoma of the head of the pancreas which is more prevalent in the female population. Palliative surgery is the only treatment modality available for many patients as this disease presents in advanced stages. This study suggests that early diagnosis and treatment play an important role in the prognosis of patients with obstructive jaundice with less recurrence in patients that were tumor free. This study highlights and emphasizes the importance of MDT as interdepartmental delay and long investigation time contribute to high mortality.

Keywords

Intervention Obstructive jaundice Whipples' procedure Malignant pathology

How to Cite This Article

Fazal MI, Bokhari SAZ, Naseem M, Tariq H, Bokhari SMZ, Fazal MU. Role of Intervention in Alleviating Symptoms of Patients with Obstructive Jaundice of Malignant Pathology; A Retrospective Study in Tertiary Care Hospital of Lahore. J Pak Soc Intern Med. 2023;4(4):302–305. doi:10.70302/jpsim.v4i4.2361

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Conflict of Interest

All authors declare no competing interests.

Disclosed in accordance with ICMJE and COPE guidelines.

Funding

No specific funding was received for this research.

Funder information follows the Crossref Funder Registry standard.

Data Availability

Data are available from the corresponding author on reasonable request.

References

Sean P Roche, Rebecca Kobos. Jaundice in the adult patient. Am Fam Physician. 2004;299–304.
2. Siddique K, Ali Q, Mirza S, Jamil A, Ehsan A, Latif S, et al. Evaluation of the aetiological spectrum of obstructive jaundice. J Ayub Med Coll Abbottabad. 2008; 20(4):62-6.
3. Jan QA, Waheed MR, Haq IUL, Khan Y. Frequency of common causes of surgical jaundice. J Med Sci. 2017;25(3):357–60.
4. Moole H, Bechtold M, Puli SR. Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review. World J Surg Oncol. 2016;14(1):182.
5. Qin LX. Hepatocellular carcinoma with obstructive jaundice: diagnosis, treatment and prognosis. World J Gastroenterol. 2003;9(3):385.
6. van der Gaag NA, Kloek JJ, de Castro SMM, Busch ORC, van Gulik TM, Gouma DJ. Preoperative Biliary Drainage in Patients with Obstructive Jaundice: History and Current Status. J Gastrointest Surg. 2009;13(4):814–20.
7. Gouma DJ, Coelho JCU, Fisher JD, Schlegel JF, Li YF, Moody FG. Endotoxemia after relief of biliary obstruction by internal and external drainage in rats. Am J Surg. 1986;151(4):476–9.
8. Gouma DJ, Roughneen PT, Kumar S, Moody FG, Rowlands BJ. Changes in nutritional status associated with obstructive jaundice and biliary drainage in rats. Am J Clin Nutr. 1986;44(3):362–9.
9. Clements WDB, McCaigue M, Erwin P, Halliday I, Rowlands BJ. Biliary decompression promotes Kupffer cell recovery in obstructive jaundice. Gut. 1996;38(6):925–31.
10. Parks RW, Clements WDB, Smye MG, Pope C, Rowlands BJ, Diamond T. Intestinal barrier dysfunction in clinical and experimental obstructive jaundice and its reversal by internal biliary drainage. Brit J Surg. 1996;83(10):1345–9.
11. Ahmad I, Jan AU, Ahmad R. Obstructive Jaundice. J Postgrad Med Inst. 2001;15(2);194-98.
12. Saddique M, Iqbal A. Management of obstructive jaundice: experience in a tertiary care surgical unit.  Pak J Surg. 2007;1(23):23-5.
13. Lawal D, Oluwole S, Makanjuola D, Adekunle M. Diagnosis, management and prognosis of obstructive jaundice in Ile-Ife, Nigeria. West Afr J Med. 1998;17(4):255–60.
14. Z Bekele, A Yifru. Obstructive jaundice in adult Ethiopians in a referral hospital. Ethiop Med J. 2000;38(4):267–75.
15. Mohammad AA, Malik QA, Mohammad AK, Mohammed G, Hamoud AWA. Biliary ascariasis: the value of ultrasound in the diagnosis and management. Ann Saudi Med. 2007;27(3):161–5.
16. Longmire Jr WP, William Traverso L. The whipple procedure and other standard operative approaches to pancreatic cancer. Cancer. 1981;47(S6):1706–11.
17. Briggs CD, Peterson M. Investigation and management of obstructive jaundice. Surgery. 2007;25(2):74-80.

Reference list indexed for Google Scholar and ResearchGate. DOI links resolve via doi.org.

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[1] Sean P Roche, Rebecca Kobos. Jaundice in the adult patient. Am Fam Physician. 2004;299–304.

[2] 2. Siddique K, Ali Q, Mirza S, Jamil A, Ehsan A, Latif S, et al. Evaluation of the aetiological spectrum of obstructive jaundice. J Ayub Med Coll Abbottabad. 2008; 20(4):62-6.

[3] 3. Jan QA, Waheed MR, Haq IUL, Khan Y. Frequency of common causes of surgical jaundice. J Med Sci. 2017;25(3):357–60.

[4] 4. Moole H, Bechtold M, Puli SR. Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review. World J Surg Oncol. 2016;14(1):182.

[5] 5. Qin LX. Hepatocellular carcinoma with obstructive jaundice: diagnosis, treatment and prognosis. World J Gastroenterol. 2003;9(3):385.

[6] 6. van der Gaag NA, Kloek JJ, de Castro SMM, Busch ORC, van Gulik TM, Gouma DJ. Preoperative Biliary Drainage in Patients with Obstructive Jaundice: History and Current Status. J Gastrointest Surg. 2009;13(4):814–20.

[7] 7. Gouma DJ, Coelho JCU, Fisher JD, Schlegel JF, Li YF, Moody FG. Endotoxemia after relief of biliary obstruction by internal and external drainage in rats. Am J Surg. 1986;151(4):476–9.

[8] 8. Gouma DJ, Roughneen PT, Kumar S, Moody FG, Rowlands BJ. Changes in nutritional status associated with obstructive jaundice and biliary drainage in rats. Am J Clin Nutr. 1986;44(3):362–9.

[9] 9. Clements WDB, McCaigue M, Erwin P, Halliday I, Rowlands BJ. Biliary decompression promotes Kupffer cell recovery in obstructive jaundice. Gut. 1996;38(6):925–31.

[10] 10. Parks RW, Clements WDB, Smye MG, Pope C, Rowlands BJ, Diamond T. Intestinal barrier dysfunction in clinical and experimental obstructive jaundice and its reversal by internal biliary drainage. Brit J Surg. 1996;83(10):1345–9.

[11] 11. Ahmad I, Jan AU, Ahmad R. Obstructive Jaundice. J Postgrad Med Inst. 2001;15(2);194-98.

[12] 12. Saddique M, Iqbal A. Management of obstructive jaundice: experience in a tertiary care surgical unit.  Pak J Surg. 2007;1(23):23-5.

[13] 13. Lawal D, Oluwole S, Makanjuola D, Adekunle M. Diagnosis, management and prognosis of obstructive jaundice in Ile-Ife, Nigeria. West Afr J Med. 1998;17(4):255–60.

[14] 14. Z Bekele, A Yifru. Obstructive jaundice in adult Ethiopians in a referral hospital. Ethiop Med J. 2000;38(4):267–75.

[15] 15. Mohammad AA, Malik QA, Mohammad AK, Mohammed G, Hamoud AWA. Biliary ascariasis: the value of ultrasound in the diagnosis and management. Ann Saudi Med. 2007;27(3):161–5.

[16] 16. Longmire Jr WP, William Traverso L. The whipple procedure and other standard operative approaches to pancreatic cancer. Cancer. 1981;47(S6):1706–11.

[17] 17. Briggs CD, Peterson M. Investigation and management of obstructive jaundice. Surgery. 2007;25(2):74-80.