Palliation of obstructive jaundice with a biliary endoprosthesis. Comparison of insertion by the percutaneous-transhepatic and the combined percutaneous-endoscopic routes.
Thirty-eight patients with obstructive jaundice due to inoperable malignancy were referred for insertion of an endoprosthesis. In 19 this was performed by the percutaneous-transhepatic route, and in 19 by a combined percutaneous-endoscopic approach. Satisfactory bile drainage was achieved in 15 patients after combined percutaneous-endoscopic insertion and in 11 after percutaneous-transhepatic prosthesis insertion. Cholangitis occurred after the combined approach in five patients and after percutaneous-transhepatic insertion in nine. None of these differences were significant. Thirty-day mortality rates and mean survival times were similar for each approach (26% and 10 weeks after combined insertion, 21% and 9 weeks after percutaneous-transhepatic). Prostheses inserted by the combined route were easily replaced when they occluded. This was not possible after percutaneous insertion. The combined percutaneous-endoscopic approach appeared to be better tolerated by the patients and is suggested as the method of choice in strictures which can not be intubated by the endoscopic route alone.
Hall
R I
RI
Department of Surgery, St James's University Hospital, Leeds, UK.
Denyer
M E
ME
Chapman
A H
AH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D002779:Cholestasis / Q000601:surgery*; D004384:Duodenoscopy; D006801:Humans; D008722:Methods; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D019736:Prostheses and Implants