title: Combined percutaneous and endoscopic procedures for bile duct obstruction: simultaneous and delayed techniques compared.
abstract: OBJECTIVE
  In patients with obstructive jaundice, when the endoscopic approach fails to achieve biliary drainage, percutaneous cannulation and combined endoscopic/percutaneous endoprosthesis insertion can be performed simultaneously or in stages. This study compared these two approaches.
  
  
  METHODS
  Over a three-year period 41 patients were studied. All had obstructive jaundice for which endoscopic drainage had failed. In 22 patients (group 1) percutaneous transhepatic drainage was followed a few days later by combined endoscopic and percutaneous procedure. In 19 patients (group 2) the percutaneous transhepatic drainage and combined drainage were performed at the same session. In the multiple stage group the mean interval between the first endoscopic retrograde cholangiopancreatography and final combined procedure was 9 days (SD 5.2). The groups were similar for sex, underlying pathology and reasons for failure of endoscopic approach. Group 1 patients were older 73 vs. 65 years (p < 0.05).
  
  
  RESULTS
  Patients in group 2 had a more rapid recovery and discharge home: mean 6 days, compared to mean 18 days from the initial procedure for group 1 (p < 0.001). Five patients died of their disease without leaving hospital (4 in group 1, 1 in group 2). In each group drainage failed in 1 patient. Complications were more common in group 1: 73% vs. 37% (p < 0.05). Pancreatitis (3 vs. 2) and septicemia (4 in group 1, 3 in group 2) were similar but group 1 had complications from the external drain: cholangitis and pyrexia in 4 patients, 3 bile leaks, and 1 catheter displacement.
  
  
  CONCLUSIONS
  When endoscopic drainage alone fails, a combined percutaneous/endoscopic procedure should only be performed if it can be carried out simultaneously.
authors.affiliation: Medical and Surgical Endoscopy Unit, Radiology Department, Royal Victoria Infirmary Newcastle upon Tyne, UK.
authors.forename: J
authors.initials: J
authors.lastname: Wayman
authors.forename: J C
authors.initials: JC
authors.lastname: Mansfield
authors.forename: K
authors.initials: K
authors.lastname: Matthewson
authors.forename: D L
authors.initials: DL
authors.lastname: Richardson
authors.forename: S M
authors.initials: SM
authors.lastname: Griffin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000209:etiology / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome