A 75-year-old male patient from Bangladesh, who presented with kidney cancer at a private hospital in the city, could not undergo the required chemotherapy as the cancer had spread to the duodenum (the first part of the small intestine), causing obstructive jaundice.
Doctors at Aster CMI hospital, where he sought treatment, said the duodenal obstruction (due to the spread of the tumour) had made him critically ill. The obstruction led to biliary stasis, a condition where the bile fluid gets blocked in the bile duct, which resulted in jaundice. The tumour was quite large, further complicating the clinical picture. Due to this condition, the patient could not undergo chemotherapy and routine endoscopic retrograde cholangiopancreatography (ERCP) stenting was not possible.
Doctors said lowering the jaundice level was crucial, as it allowed for chemotherapy treatment of the primary tumour.
“High jaundice levels can interfere with the effectiveness of chemotherapy. Typically, a stent from the duodenum is inserted into the bile duct to allow bile to flow. However, due to the large size of the tumour, we opted for a more direct approach. We used a novel endoscopic ultrasound-guided technique to create a connection between the duodenum and the bile duct,” said Naresh Bhat, Chief of Gastroenterology at the hospital.
“This procedure used a wall-opposing stent and involved puncturing the duodenum and inserting a wire into the bile duct, followed by the placement of a stent to create a passage for bile flow between the duodenum and the blocked bile duct. This minimally invasive intervention was a relatively quick procedure, taking approximately 5 to 10 minutes. It alleviated the patient’s jaundice,” the doctor explained.
“This procedure is uncommon as endoscopic ultrasound-guided techniques are not widely adopted. The procedure’s significance lies in its ability to achieve results in a matter of minutes, which would typically require hours of surgical intervention. By addressing the jaundice, we were able to initiate chemotherapy, which is crucial for managing his kidney cancer,” the doctor said.
“The primary objective to provide palliative care with minimally invasive techniques, thereby ensuring a short hospital stay as well as minimal discomfort to improve the patient’s quality of life for as long as possible, has been accomplished through this technique,” he added.
