title: What is appropriate procedure for preoperative biliary drainage in patients with obstructive jaundice awaiting pancreaticoduodenectomy?
abstract: OBJECTIVE
  The aims of this study were to compare the clinical outcomes of the preoperative drainage methods in patients with obstructive jaundice awaiting panreaticoduodenectomy and to determine, which procedure would be more effective for preoperative drainage.
  
  
  METHODS
  Among 239 patients undergoing pancreaticoduodenectomy for periampullary cancer, 77 with obstructive jaundice underwent percutaneous transhepatic biliary drainage (PTBD, n=34) or endoscopic biliary drainage (EBD, n=43).
  
  
  RESULTS
  Median rate of decrease in bilirubin was 0.65 mg/d in PTBD group and 0.34 mg/d in EBD group (P=0.003). Median interval from preoperative drainage to pancreaticoduodenectomy were 11 days in PTBD group and 18 days in EBD group (P=0.009). Overall indwelling catheter-related complication rates were higher in "EBD" group compared with "PTBD" group (23.3% vs. 2.9%, P=0.019). No catheter occlusion developed in "PTBD" group, but 6 stent occlusions (13.3%) developed in "EBD" group (P=0.031). The mortality rate was not significantly different between the 2 groups.
  
  
  CONCLUSIONS
  Percutaneous biliary drainage may be preferred for preoperative drainage in patients with obstructive jaundice awaiting pancreaticoduodenectomy due to rapid biliary decompression and lower frequency of catheter-related complications.
authors: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea.
authors: Seon-Young
authors: SY
authors: Park
authors: Chang-Hwan
authors: CH
authors: Park
authors: Sung-Bum
authors: SB
authors: Cho
authors: Wan-Sik
authors: WS
authors: Lee
authors: Jung-Chul
authors: JC
authors: Kim
authors: Chul-Kyun
authors: CK
authors: Cho
authors: Young-Eun
authors: YE
authors: Joo
authors: Hyun-Soo
authors: HS
authors: Kim
authors: Sung-Kyu
authors: SK
authors: Choi
authors: Jong-Sun
authors: JS
authors: Rew
mesh_terms: D000368:Aged; D057785:Catheters; D004322:Drainage / Q000379:methods*; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome