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Gastroenterology
Diseases Of The    Oesophagus
 

Benign And Malignant Strictures

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Q. How to differentiate benign from malignant bile duct strictures ?

The main etiology of bile duct strictures closely related to the liver is a malignancy (cancer). However, the differentiation of benign and malignant strictures is notoriously difficult.

The consequences for the patient are considerable because cancer in this anatomical location requires extensive surgery with removal of a large part of the liver. Extensive work-up including multi-slice computed tomography (CT), colour Doppler ultrasonography and magnetic resonance imaging (MRI) may improve the diagnostic dilemma. However, up to date, no single investigation reliably differentiates malignant from benign bile duct strictures.

A research article to be published on August 28, 2008 in the World Journal of Gastroenterology addresses this question. The research team led by Prof. van Gulik from the Surgical Department, analyzed a patient cohort that underwent resection for presumed malignancy of the bile duct, during the period 1998 to 2006. The final histologic diagnosis of 68 patients was correlated with the preoperative clinical, laboratory and radiological findings.

Fifteen percent patients were found to have a benign lesion. The findings of the different imaging studies revealed that only one feature, i.e. involvement of the blood vessels, showed a significant association with malignany. All other features including clinical presentation, laboratory tests, brush cytology, and other imaging studies were unable to differentiate malignant and benign strictures.

Invasion of the blood vessels was based on the findings of colour Doppler ultrasonography defined as an increase of flow compatible with stenosis, or absence of flow compatible with occlusion. Furthermore, vascular involvement was identified on contrast enhanced CT as vascular stenosis or occlusion of the portal vein and/or the hepatic artery. In 21 patients, the portal vein and/or branches of the hepatic artery were involved in the tumor process, and all these patients were finally diagnosed to have a malignant lesion.


The list of of Gastroenterology Hospitals in India is as follows : -


Apollo Hospitals Bangalore Apollo Hospitals, Bangalore, India
Apollo Hospital Chennai Apollo Hospital, Chennai, India
Apollo Hospitals Hyderabad Apollo Hospitals, Hyderabad, India
Apollo Hospitals Delhi Indraprastha Apollo Hospital, Delhi, India
Apollo Hospitals Kolkata Apollo Gleneagles Hospital, Kolkata, India
Apollo Hospital, Goa, India Apollo Hospital, Goa, India
Wockhardt Hospital Bangalore India Wockhardt Hospital, Bangalore India
Wockhardt Hospital hyderabad, India Wockhardt Hospital, hyderabad, India
Wockhardt Hospital Mumbai, India Wockhardt Hospital, Mumbai, India
Fortis Hospital, Delhi, India Fortis Hospital, Delhi, India
Fortis Hospital Mohali, India Fortis Hospital, Mohali, India
Fortis Hospital Noida, India Fortis Hospital, Noida, India
Manipal Hospital, Bangalore, India Manipal Hospital, Bangalore, India
Sparsh Hospital, Bangalore, India Sparsh Hospital, Bangalore, India
Artemis Hospital, Gurgaon ( Delhi ) , India Artemis Hospital, Gurgaon ( Delhi ) , India
Max Super Specialty hospital,  Delhi, India Max Super Specialty hospital, Delhi, India
Max Devki Devi Heart and Vascular  hospital,  Delhi, India Max Devki Devi Heart and Vascular hospital, Delhi, India
Max Health Check Centre, Delhi, India Max Health Check Centre, Delhi, India
BGS Global Hospital Bangalore, India BGS Global Hospital, Bangalore, India
BGS Global Hospital Chennai, India BGS Global Hospital, Chennai, India
BGS Global Hospital Hyderabad, India BGS Global Hospital, Hyderabad, India


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