Clinical Outcome of Consecutive Non-Operative Management for Palliation of Malignant Biliary and Duodenal Obstruction

Abstract

Background: Malignancies of the gastrointestinal tract sometimes cause symptomatic biliary and duodenal obstruction, which occur one after another. However, most of them are frequently unresectable to be cured and receive palliative care only. Non-operative management has offered less invasive alternatives to surgical palliation of the symptomatic duodenal and biliary obstruction. Methods: The consecutive 23 patients with unresectable malignant biliary and duodenal obstruction, in whom non-operative managements were performed between February 1998 and March 2004, were retrospectively analyzed. Self-expanding metal stents were endoscopically inserted for the palliation of the duodenal obstruction, while the self-expanding biliary metal stent insertion or percutaneous biliary drainage was performed for the palliation of the biliary obstruction. Results: The total 23 patients had the following underlying diseases: pancreatic cancer 11, gallbladder cancer 3, common bile duct cancer 3, ampullary cancer 3, and gastric cancer 3. Self-expanding metal stents were endoscopically inserted for the palliation of duodenal obstruction in all the patients without immediated complications. Seventeen patients had previous biliary obstructions before duodenal obstructions. Ten of them were treated with an endoscopic placement of a biliary stent and the remaining 7 patients were treated with a percutaneous biliary drainage for biliary obstruction. Symptomatic duodenal obstructions were developed with a mean of 121 days after the biliary obstruction. During the follow-up, 1 patient had recurrent jaundice due to biliary stent occlusion and was managed with a percutaneous biliary drainage. Six patients had previous duodenal obstructions before biliary obstructions. One of them was treated with an endoscopic placement of a biliary stent and the remaining 5 patients were treated with a percutaneous biliary drainage due to biliary obstruction. Symptomatic biliary obstructions were developed with a mean of 28 days after the duodenal obstruction. During the follow-up, 1 patient with a percutaneous biliary drainage had recurrent jaundice and was managed with a percutaneous biliary stent. Conclusion: Non-operative management of the malignant biliary and the duodenal obstruction may provide a safe and less invasive alternative to surgical palliation with an acceptable clinical outcome.