title: Endoscopic palliation of malignant obstructive jaundice using resterilized accessories: an audit of success, complications, mortality and cost.
abstract: OBJECTIVE
  To assess the success, complications and cost of endoscopic endoprosthesis placement for palliation of obstructive jaundice caused by malignancy.
  
  
  METHODS
  Four hundred and two consecutive patients with obstructive jaundice due to nonresectable malignancy undergoing endoscopic stenting were studied. Commercial or home-made 7F or 10F endoprostheses were placed using minor modifications of the standard technique. The accessories were sterilized and reused.
  
  
  RESULTS
  Endoprosthesis placement was successful in 291 patients (72.4%, 95% CI 67.7-76.7)-241 in one attempt, 49 in two attempts, and one in three attempts. Fifty nine patients (14.6%, 95% CI 11.4-18.6) had procedure-related complications, including cholangitis (30), pancreatitis (15), perforation (3) and bleeding (11). The incidence of cholangitis was significantly higher in bifurcation blocks than in other lesions (17.6% vs 4.7%, p = 0.0005). The success rate did not differ between distal and proximal lesions (68.1% vs 72.9%). The procedural cost per patient could be reduced from Rs 14,850 to Rs 6565 by reusing accessories after sterilization, and using home-made stents.
  
  
  CONCLUSIONS
  Endoscopic endoprosthesis placement is a safe and effective method for palliation of malignant obstructive jaundice. Preparation of indigenous stents and reuse of accessories can reduce the cost of the procedure by over 50%.
authors.affiliation: Division of Medical Gastroenterology, Tata Memorial Hospital, Mumbai.
authors.forename: V S
authors.initials: VS
authors.lastname: Swaroop
authors.forename: V
authors.initials: V
authors.lastname: Dhir
authors.forename: K M
authors.initials: KM
authors.lastname: Mohandas
authors.forename: S D
authors.initials: SD
authors.lastname: Wagle
authors.forename: K F
authors.initials: KF
authors.lastname: Vazifdar
authors.forename: G
authors.initials: G
authors.lastname: Gopalakrishnan
authors.forename: O P
authors.initials: OP
authors.lastname: Sharma
authors.forename: P
authors.initials: P
authors.lastname: Jagannath
authors.forename: L J
authors.initials: LJ
authors.lastname: Desouza
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002779:Cholestasis / Q000150:complications / Q000209:etiology / Q000601:surgery*; D003362:Cost-Benefit Analysis; D004724:Endoscopy / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000150:complications / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011475:Prosthesis Failure / Q000191:economics*; D012189:Retrospective Studies; D012449:Safety; D015607:Stents / Q000009:adverse effects*; D013242:Sterilization; D015996:Survival Rate; D016896:Treatment Outcome