NMS. Casos Clínicos

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Chapter 7 ♦ Pancreatic and Hepatic Disorders

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raphy to demonstrate the level of obstruction. For lesions very proximal in the bile duct, percutaneous transhepatic cholangiography is preferable because it visualizes the proximal hepatic ducts better than ERCP. Biopsies and cytology may also be performed during these procedures to make the diagnosis of cancer. On ERCP, you find a constricting lesion typical of a Klatskin tumor. The biopsy returns cholangiocarcinoma. Figure 7-20: Periampullary malignancies, such as pancreatic cancer and cholangiocarcinoma, result in gastric outlet obstruction and biliary obstruction. A. Dual stent placement for biliary and duodenal obstruction in a patient with cholangiocarcinoma. B. Deployed duodenal wall stent in position. (From Swanström LL, Soper NJ. Mastery of Endoscopic and Laparoscopic Surgery , 4th ed. Wolters Kluwer Health; 2013, Fig. 38-19B and 38-18D.) SAMPLE B