title: Endoscopic stenting versus surgical bypass in advanced malignant distal bile duct obstruction: cost-effectiveness analysis.
abstract: OBJECTIVE
  Palliative treatment of obstructive jaundice from advanced tumour of the distal bile duct is controversial. The aim of this study was to compare the clinical outcomes and costs between endoscopic stent insertion and surgery.
  
  
  METHODS
  The clinical data for 116 patients treated with either endoscopic plastic stenting (65 patients) or surgical bypass (51 patients) were reviewed and analysed.
  
  
  RESULTS
  No significant difference was found between the two groups in terms of the length of hospital stay, survival time, cost, effectiveness, and early complications. However, late complications were significantly more common in the stenting group (p = 0.007). Jaundice recurred in 15 stented patients at a median time of 3 months due to stent blockage, and one surgical patient had recurrent jaundice from anastomosis stricture. Late gastric outlet obstruction occurred in one of 36 surgical patients who did not undergo prophylactic gastroenterostomy and one of 65 stented patients developed this complication.
  
  
  CONCLUSIONS
  Both techniques are equally effective in biliary drainage, but stenting has a higher rate of recurrent jaundice. We recommend surgery for patients with low surgical risks and endoscopic stent in those with a short life expectancy or those unfit for surgery.
authors.affiliation: Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand. susomkia@medicine.psu.ac.th
authors.forename: Somkiat
authors.initials: S
authors.lastname: Sunpaweravong
authors.forename: Bancha
authors.initials: B
authors.lastname: Ovartlarnporn
authors.forename: Uthai
authors.initials: U
authors.lastname: Khow-ean
authors.forename: Prinya
authors.initials: P
authors.lastname: Soontrapornchai
authors.forename: Vicha
authors.initials: V
authors.lastname: Charoonratana
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002779:Cholestasis / Q000601:surgery*; D003362:Cost-Benefit Analysis; D004067:Digestive System Neoplasms / Q000150:complications*; D013505:Digestive System Surgical Procedures / Q000191:economics / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000191:economics / Q000379:methods*; D015607:Stents; D016896:Treatment Outcome