الفهرس 
Introduction
Pathophysiology of cholestasisOnly 14 pages are availabe for public view
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Abstract
Summary
The current study was a retrospective one which aimed to determine the etiological spectrum of obstructive jaundice in the last five years (from jaunary 2011 till jaunary 2016) using ERCP records.
It included two Groups of patients were diagnosed to have obstructive jaundice and ERCP was done for them.
group I where ERCP was done at Endoscopy Unit of Assiut University Hospital and included 700 patients and group II where ERCP was done at Endoscopy Unit of Al Rajhi University Hospital and included 320 patients.
Regarding the clinical presentations, jaundice was the most frequent symptom/sign that occurred in all patients (100%) followed by abdominal pain in (87.5%). charcot triad and palpable gall bladder were noticed (15.625%) and (7.5%) patients respectively.
As regard to imaging studies, abdominal US was diagnostic for the cause of obstruction in 62.5% of patients with sensitivity, and specificity in diagnosing biliary stone (71.43% and 81.81% respectively). While the sensitivity of abdominal US in case of biliary stricture was 37.5% vs. 92.68% specificity. In addition, the sensitivity, and specificity of abdominal US in diagnosing biliary pancreatic mass were 20% and 96.29% respectively.
The sensitivity of MSCT scan in detection of biliary stricture was 100% vs. 50% specificity. However, it had 50% sensitivity vs. 100% specificity in diagnosis of biliary pancreatic mass.
In contrast, the sensitivity and specificity of MRCP were 100% in cases of biliary strictures and biliary pancreatic masses.
Regarding to ERCP findings among total cases (N =1020), calcular obstructive jaundice was the predominant finding in 63.8% of patients followed by malignant obstructive jaundice and biliary stricture in (21.5%) and (14.7%) of patients respectively.
Interventions varied according the findings. Those interventions were only removal of stone, removal of stone and stenting, only stenting or biopsy and stenting in (29.5%, 25.5%, 12.7%, and 27.4%) of patients respectively.
Failed cannulation of the papilla occurred in (4.9%) of all patients, (1.9%) with calcular obstructive jaundice, (1.9%) with malignant obstructive jaundice and (1%) with biliary stricture. Further management of those patients was done according to the findings. Those with calcular obstructive jaundice were subjected to surgery, and those with biliary stricture or malignant obstructive jaundice had external drainage known as percutaneous transhepatic drainage (PTD).
About 6.9% of patients with calcular obstructive jaundice and difficulty in removing the stone, stenting was used and then surgical consultation was done later on. Thirty patients from those with billiary stricture and had stenting came for re-stenting due to obstruction of previous one [30/ total 1020 (2.9%) and (30/150 with stricture (20%)]. We did not know histopathology results of biopsy taken due to defect in data recording.
It was noted that higher percentage of calcular obstructive jaundice was found in male than female (69.2% versus 30.8%). In addition, nearly most of malignant obstructive jaundice were found in male. More than three fifth of biliary stricture were found in male.
Calcular obstructive jaundice in the current study was common in age group 40-60 years (57.7%) followed by age group less than 40 years (40%), while malignant obstructive jaundice was found to be more common in age group more than 60 years (59.1%) and lastly biliary stricture was more common in the age group below 40 years (64.7%). The present study showed that among patients had malignant lesions in ERCP, cholangiocarcinoma was the commonest (43.6%), followed by pancreatic carcinoma, and malignant biliary stricture in (35.4%) and (21%) of patients respectively.