title: Clinical impact of biliary drainage and jaundice resolution in patients with obstructive metastases at the hilum.
abstract: OBJECTIVE
  For patients presenting with progressive liver or lymph node metastases (LM) causing obstructive jaundice, survival without adequate biliary drainage is very brief. The aim of this study was to assess the impact of endoscopic drainage for biliary obstruction secondary to LM at the hilum on subsequent administration of chemotherapy and on patient outcome.
  
  
  METHODS
  Thirty-five patients were studied and underwent insertion of plastic and/or metal stents, endoscopically (80%) or percutaneously and endoscopically (20%), to obtain complete resolution of jaundice. LM originated from colon (n = 16), gastric (n = 5), breast (n = 5), pancreatic (n = 3), and miscellaneous cancers (n = 6). Bile duct strictures were Bismuth type I-II in 13 patients and type III in 22.
  
  
  RESULTS
  The overall rate of success (i.e., complete resolution of jaundice) was 86% after a median of three procedures per patient (range, 1-7). Pruritus, jaundice, nausea, abdominal pain, and anorexia improved significantly in 88, 86, 75, 66, and 50% of cases, respectively. Overall median survival was 4 months and was 6.5 versus 1.8 months (p < 0.05) in the groups of patients whose jaundice resolved completely versus incompletely. The type of stricture did not affect survival. Patients with colon and breast cancer who were eligible for second line chemotherapy after optimal drainage had the longest survival (12-16 months).
  
  
  CONCLUSIONS
  In our patients with obstructive LM, endoscopic biliary drainage completely resolved jaundice in 86% and improved clinical symptoms and survival, thus enabling these patients to have additional chemotherapy.
authors.affiliation: Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Van Laethem
authors.forename: Sébastien
authors.initials: S
authors.lastname: De Broux
authors.forename: Pierre
authors.initials: P
authors.lastname: Eisendrath
authors.forename: Michel
authors.initials: M
authors.lastname: Cremer
authors.forename: Olivier
authors.initials: O
authors.lastname: Le Moine
authors.forename: Jacques
authors.initials: J
authors.lastname: Devière
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002779:Cholestasis / Q000209:etiology / Q000601:surgery*; D004322:Drainage / Q000379:methods; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents