Chandigarh, May 22
The Post Graduate Institute of Medical Education and Research (PGIMER) here has developed an endoscopic method of relieving obstructive jaundice that occurs in cancer patients.
Even if the disease is widespread, jaundice starts decreasing and disappears within four weeks with the help of a technique developed by Dr Virendra Singh, Associate Professor in the PGI’s Department of Hepatology.
Addressing a press conference this afternoon, the doctor said itching caused by jaundice disappeared in patients and their appetite improved. Some patients even gained weight, resulting in better quality of life. The patients, he added, survived for six months to one year. No patient developed fever after the procedure, he said. The Head of the Radiotherapy Department, Dr S.C. Sharma, also addressed the media.
Dr Virendra Singh said obstructive jaundice due to cancer was frequently seen in this part of the country. The patients experienced itching, clay-coloured stools, with or without fever, and loss of appetite, besides weight loss.
Obstruction of the bile duct, he said, could be at the lower end or at the upper end. Lower-end biliary obstruction was primarily due to the cancer of pancreas, bile duct or duodenum. If detected early, surgery was possible. Otherwise, a plastic or a metal stent was put to relieve jaundice by endoscopic retrograde cholangio-pancreatography (ERCP).
Comparing the two stents, he said a metal stent could expand up to 10 mm in diameter as compared to 2.5 mm in the case of a plastic stent. Hence, a metal stent could remain in the patients for a longer time, say six or nine months; a plastic stent could go up to three months. However, the cost of the metal stent was approximately Rs 30,000.
If jaundice was due to the obstruction of the bile duct at the upper end, it was mainly due to carcinoma gallbladder, a common occurrence in North. Other causes included cancer of the bile duct or any other cancer spreading into liver.
Dr Virendra Singh’s paper, “Contrast-free unilateral endoscopic palliation in malignant hilar biliary obstruction: New method”, was published in the May issue of Journal of Gastroenterology and Hepatology, Australia. It was also given ISGCON-2003 poster session award by the Indian Society of Gastroenterology at Chennai in November last year. Till date, Dr Virendra Singh had treated about 25 patients using the new method. No other centre in the country was practising the procedure, he claimed.
In collaboration with the Department of Radiotherapy, he had also started endoscopic intraluminal brachytherapy in patients with malignant obstructive jaundice.
In this method, a metal stent was put for relieving obstructive jaundice. Once the patient became jaundice free, a special catheter was passed through an endoscope during ERCP and left inside the metal stent, he explained. High dose radiation was given at the desired site with the help of Iridium 192 source for about five minutes, he said. The advantage of the intraluminal brachytherapy was that it did not irradiate adjacent structures as in external radiotherapy. High-dose radiation resulted in decreasing the tumor size. The results of the procedure were encouraging. Patients with carcinoma gallbladder had lived for six months to two years following the procedure.
