Biliary and duodenal bypass for carcinoma of the head of the pancreas

Abstract

A review was undertaken of 66 patients having palliative bypass surgery for carcinoma of the head of the pancreas. A second laparotomy for relief of duodenal obstruction was necessary in six of 29 (20%) of the patients who did not have gastroenterostomy performed initially, but late gastric outlet obstruction occurred only once in 37 patients having an initial gastroenterostomy (P less than 0.05). Cholecystojejunostomy failed to provide permanent biliary bypass in 14 of 53 (26%) patients, compared to successful drainage in all 13 patients having anastomosis of the common hepatic duct to the jejunum (P less than 0.05). In seven patients cholecystojejunostomy was performed when the cystic duct was already obstructed by tumour. Therefore prophylactic gastrojejunostomy is recommended as a routine. The gallbladder should only be used for biliary bypass when appropriate contrast x-rays have demonstrated the patency of the cystic duct.

Outcomes and limitations in EUS-guided gallbladder drainage

“…[9] In addition, results from multiple surgical series on cholecystojejunostomy demonstrated that the overall rate of recurrent biliary obstruction of 8%–48%. [101112] Thus, in patients with failed ERCP, EUS-guided biliary drainage should still be the first option, and in cases where EUS-guided biliary drainage (EUS-BD) is not possible, then EUS-GBD can be considered.…”

Systematic review and meta-analysis of prophylactic gastroenterostomy for unresectable advanced pancreatic cancer

“…For palliation of unresectable cancer, a French multicentre study by Huguier and co‐workers15, 16 and an American study by Neuberger and colleagues17 supported a combined biliary and gastric bypass because of the higher incidence of reoperative gastric bypasses in the group undergoing biliary bypass placement alone and an equal mortality rate in the double bypass group. This approach is supported by several other studies18–23. On the other hand, de Rooij and co‐workers23 and Egrari and O'Connell24 proposed selective reoperation for obstruction.…”

Palliative Interventional and Surgical Therapy for Unresectable Pancreatic Cancer

“…Huguier et al and Neuberger et al recommended simultaneous biliary and enteral bypasses on the basis of comparable mortality (single versus double bypass), but found an increased need for gastric bypass at a later date (when most patients' physical condition has deteriorated) in patients who initially only received biliary drainage [39,40]. This approach is supported by the results of several other studies [41-44]. On the contrary, other authors emphasize in particular the selective aspect of performing a double bypass in patients with advanced pancreatic cancer.…”