Management

Endoscopy is currently not only an important diagnostic tool but also provides important therapeutic options for patients with benign and malignant biliary ducts obstruction. The endoscopic guide wire should be placed into the bile ducts proximal to obstruction. The next key step is endoscopic biliary sphincterotomy to provide easier and reliable access to the common bile duct. In patients with high grade obstruction, the place of obstruction may need to be dilatated with Sohendra dilatators over the wire and then a dilatating biliary balloon advanced over the wire and inflated for 30 seconds on 2 occasions. If the obstructive lesion is longer than the length of the dilation balloon, it usually requires several placements of the dilatating balloon. It is technically easier first to place the balloon to the most proximal portion of the lesion and dilatate it and then to pull the balloon down to dilatate middle and more distal portions of the lesion.

Patients with benign strictures require dilatation followed by placement of the biliary plastic stents. It is recommended to place the stent of maximal diameter (10 F) and if possible, to place 2 or even 3 stents along side of each other to keep the maximal residual diameter possible. These plastic stents should be electively exchanged every 2 to 3 months over the period of 12 months to prevent restricturing after the dilatation. The goals of endoscopic therapy are to keep the patient symptom-free with sustained normalization of liver function tests. Unfortunately, some of the biliary strictures can recur many years after treatment. Close monitoring of liver function tests and abdominal USs (to evaluate the diameter of biliary ducts) are recommended every 3 months during the first year after treatment and at 6-month intervals thereafter.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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