Inappropriateness in biliary stenting

Submitted: 8 May 2013
Accepted: 24 June 2013
Published: 25 October 2013
Abstract Views: 1437
PDF: 730
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Authors

Starting from a real case of a 69-year old patient affected by cholangiocarcinoma, we intend to discuss the accuracy and appropriateness of the diagnostic and therapeutic procedures adopted. This case shows in particular that a more accurate preoperative staging could probably avoid the patient unnecessary laparotomy. According to the indications in the medical literature, this patient could possibly benefit from chemotherapy, but a chemoembolization of liver metastases was performed. However in the literature no available evidence suggests that this treatment would be beneficial in this kind of clinical picture. Eventually, when the disease was already at an advanced stage and worsened due to a necrosis of the left hepatic lobe and a cholangitic infection, a repositioning of the stent on the stent was performed, despite in the literature the life expectancy cut-off for this procedure is at least 6 months. We also discuss the communication between the physician, the patient and the family, which was probably based on overly optimistic and unrealistic expectations. This led to a number of surgical procedures, which were not certainly helpful and indeed were probably even harmful for this patient. In addition, these procedures caused unnecessary costs borne by the healthcare system. In conclusion, we advocate that discussion and self-assessment must be always promoted, so that the healthcare professionals can review the process and the outcome of their treatment as well as their behavior to understand if it could have been more appropriate to offer actual benefits to the patients in terms of better quality of life and longer life expectancy.

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Citations

Giuseppe Chesi, Department of Internal Medicine, Scandiano Hospital, Azienda USL Reggio Emilia
Chief of Internal Medicine Department
Antonio Faraone, Department of Internal Medicine, Scandiano Hospital, Azienda USL Reggio Emilia
Medical Doctor
Claudio Giumelli, Department of Internal Medicine, Scandiano Hospital, Azienda USL Reggio Emilia
Medical Doctor

How to Cite

Chesi, G., Faraone, A., & Giumelli, C. (2013). Inappropriateness in biliary stenting. Italian Journal of Medicine, 8(2), 121–123. https://doi.org/10.4081/itjm.2013.383

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