TY  - GEN
AU  - Adhikari, Shital.
TI  - Aetiological incidenceof obstructive jaundice androle of endoscopic retrograde cholangiopancreatography in it's evaluation and therapy in nepalese set up
PY  - 2001///
KW  - Aetiologicalincidence
KW  - Jaundice
KW  - Cholangiopancreatography
N1  - Thesis Report
N2  - ABSTRACT:  1. Objectives: 1.	To determine the aetiological incidence of the obstructive jaundice in our centres.  2.	To assess the role of Endoscopic Retrograde Cholangiopancreatography in its evaluation and therapy in our set up.   2. Design: Prospective  cross-sectional descriptive study of 50 consecutive patients of obstructive jaundice   3. Setting: Patients with obstructive jaundice admitted in Bir and Kathmandu hospitals.  4.Subjects: Patients with features of cholestasis with or without cholangitis and cholestatic picture on liver function tests and ultrasound showing common blie duct diameter > 8mm were included in the study.  5. Observations: Out of 50 patients included in the study, 40% were male and 60% female; the commonest age group was 61-70 years. Most of the patients presented with multiple complaints but almost all (92%), vomiting 960%), weight loss (48%) and right hypochondriac pain (40%) were the other complaints. 16% patients (all with malignant cause) had ascites at presentation and 4% had metastatic deposit at left supraclavicular lymph node. 80% patients had prolonged PT (difference > 4sec) but it was correctable in 96% of cases with vitamin K1.  With endoscopic retrograde cholangiopancreatography, visualization of the biliary and pancreatic tree (when indicated) was acjoeved om 97.5% cases and diagnosis was established correctly in 98% cases. Removal of common bile duct stome by endoscopic sphincterotmy was successful in 77.77% case, stenting for malignant biliary stricture in 66.66% and removing parasites obstructing the common bile duct in 100%. Mortality was only 2% and hospital stay was significantly less (1.74+-1.84 versus 15.666+-3.65 days) when compared with the mean hospital stay of patients undergoing surgical procedure (p=0.0035).    The commonest cause of obstructive jaundice in our centres was choledocholithiasis (48%) followed by carcinoma of the head of pancreas (14%) and carcinoma of the gallbladder (12%). Parasites (3%), post-operative biliary stricture 93%) and cholangiocarcinoma (2%) were less frequent causes.  6. Conclusion: Choledocholithiasis was the commonest cause of obstructive jaundice (48%) with female predominance followed by carcinoma of the head of pancreas (14%) with male predominance and carcinoma of the gallbladder (12%) with male to female ratio of 1:5. Visualisation of pancreaticobiliary tree was achieved in 97.5% cases by endoscopic retrograde cholangiopanereatography and diagnosis was established correctly in 98% cases. The therapeutic success was 77.77% in common bile duct stone removal, 66.66% in stenting the duct in malignant stricture and 100%  in removing parasites obstructing the common bile duct. Mortality was low only 2% and hospital stay was significantly less.
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