Malignant biliary strictures - a flexible view: review

Endoscopic stenting of malignant biliary strictures offers a relatively safe and cost effective treatment for unresectable malignancies. Jaundice and pruritis can be relieved and this is accompanied by an improved quality of life. The main problem with endoscopic stents is their tendency to block with time. Attempts to extend their useful life have been made by modifying the shape and composition of plastic stents and more successfully, by the introduction of wide bore metal stents. The need to drain all areas of biliary obstruction has been questioned and the role of preoperative biliary drainage has been explored by meta-analyses of previous trials. Palliative intervention for obstructive jaundice in pancreatic and biliary cancer may involve ERCP with stenting or surgery. The available evidence does not indicate a major advantage to either alternative so the choice may be made depending on clinical availability and patient or practitioner preference. Predicted survival The technical skills to perform ERCP are widely available and this modality may be preferred to surgery in some cases due to the lower overall resource utilization and shorter hospitalization. The above paragraph is taken from the United States National Institute of Health State Of The Art Conference Statement on the role of ERCP and diagnosis therapy published in June 2002. SA Gastroenterology Rev. Vol.1(2) 2003:9-1

The role of stem cell transplantation in the management of relapsed follicular lymphoma in the era of targeted therapies

Patients with relapsed follicular lymphoma (FL) following first-line therapy have an increasing number of management strategies ranging from observation through to stem cell transplantation. There has been an exciting expansion in novel agents to treat FL, but at present there is not a universally accepted standard of care in the relapse setting. Decision-making can be difficult for the clinician as there is a paucity of data to compare the various relapse therapies available. This review will discuss conventional therapy for relapsed FL, consider the use of novel agents and explore the role and timing of autologous and allogeneic stem cell transplantation