Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice.

Abstract

In recent years, endoscopically placed endoprosthesis has become an alternative to traditional operative biliary-digestive bypass in palliative treatment of patients with non-resectable biliary obstruction caused by malignant stricture of the extrahepatic bile duct. In an uncontrolled series the endoscopic approach has been recommended as the treatment of choice.' Alternatively surgery has been recommended primarily because 13% of the survivors needed a later operation for duodenal obstruction.2 The combined intraoperative and postoperative mortality (30 days mortality) after bypass surgery is reported to be 15-30%,2 and the corresponding mortality for the endoscopic approach 10-18%.'3 The procedure related mortality of endoprosthesis insertion was low (0-2%),' and success rates in the application of the stent were high (90%).' Sonnenfeld et al' reported a non-randomised comparison of endoprosthesis versus bypass with 20 patients in each group and found no difference in survival, but the

Are There Indications for Palliative Resection in Pancreatic Cancer?

“…However, recurrence of jaundice with or without cholangitis is more frequently reported after the use of stents. Four prospective randomized trials have shown that recurrent jaundice/cholangitis was more frequent after stenting (up to 38%) than after bypass surgery (3-10%) [23][24][25][26]. Whether these short periods of recurrent jaundice/cholangitis and subsequent stent changes have any effects on the quality of life of these patients remains to be analyzed.…”

Cost-Effectiveness Decision Analyses Comparing Covered to Uncovered Self-Expandable Metal Stents to Elective or on Demand Polyethylene Stent Changes in Patients with Distal Malignant Biliary Obstruction

“…[16,18]. While overall survival did not differ between treatments, they demonstrated that endoscopic stenting had a lower rate of short-term complication than surgical treatment.…”

“…Although very effective in relieving obstruction and preventing reocclusion due to direct tumor invasion, surgical biliary bypass (e.g. hepatojejunostomy) is associated with a high rate of complications, a long hospital stay and consequently high costs [16][17][18][19]. Percutaneous insertion of plastic and metallic stents is also effective in the palliation of malignant obstruction, especially in the presence of dilated intra-hepatic radicals.…”

Pancreatic cancer

“…[47][48][49][50] Although nonoperative palliation is associated with decreased procedure-related morbidity and mortality and a shorter initial hospitalization, its principle limitation is the tendency of the stent to occlude from biliary sludge and debris. Stent occlusion may occur in 35 percent of patients, and rehospitalization for treatment of cholangitis secondary to stent occlusion impacts on the quality of life and may outweigh the morbidity of operative palliation.…”