Long-term results of endoscopic treatment of biliary duct obstruction due to pancreatic disease.
OBJECTIVE
Endoscopic stenting has become an established method of providing palliative treatment in cases of malignant biliary obstruction, as well as in benign biliary stenosis. Several problems associated with the types of stent used have not yet been resolved, and an ideal stent has yet to be designed. Observation of the clinical course for patients with biliary obstruction of various etiologies, and evaluation of the results with various treatment methods are the aims of this study.


METHODS
In 1993 and 1994, biliary obstruction was treated endoscopically in 47 patients with a malignant pancreatic tumor and in 18 patients with chronic pancreatitis. The primary intervention was assessed retrospectively on the basis of the patients' records, and information concerning the clinical course was obtained by contacting the patients or their relatives or general practitioners.


RESULTS
Primary endoscopic drainage was successful in all cases. Only one of the patients with pancreatic tumors is still alive; survival after stent placement averaged 6.2 months. Metal stents remained patent significantly longer than plastic stents and percutaneous transhepatic biliary drains (PTBDs)(8.2 versus 3.5 or 1.9 months; p < 0.001). In cases of chronic pancreatitis, three of the nine patients who received only endoscopic treatment, without stenting, were able to continue without stents in the longer term, whereas seven of the nine who underwent surgery had no further problems.


CONCLUSIONS
Endoscopic drainage of biliary obstruction provides excellent short-term results. In long-term treatment for purely palliative purposes, metal stents remain patent for longer than plastic stents. In chronic pancreatitis, surgical treatment clearly seems to provide better long-term results than endoscopic therapy.
II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universitat München, Germany.
P
P
Born
T
T
Rosch
K
K
Bruhl
K
K
Ulm
W
W
Sandschin
E
E
Frimberger
H
H
Allescher
M
M
Classen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002779:Cholestasis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D004724:Endoscopy / Q000009:adverse effects / Q000401:mortality; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000150:complications* / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000150:complications / Q000401:mortality; D010195:Pancreatitis / Q000150:complications / Q000401:mortality; D010969:Plastics; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D008670:Metals; D010969:Plastics