Endoscopic palliative treatment for malignant obstructive jaundice: A report of 929 cases

Abstract

To review the experience with endoscopic palliative treatment for malignant obstructive jaundice (MOJ) in 929 patients. 929 patients (598 males and 331 females) underwent 1215 endoscopic palliative drainages for MOJ in our hospital. Tumor obstruction occurred in the distal common bile duct (CBD) (263 patients), the middle CBD (43), and the hilum (909). The mean bilirubin level was 284.3 μmol/L (range 26–810). Of the 1215 drainages, 599 were performed by stenting with plastic endoprosthesis, 385 by naso-biliary catheterization, 167 by expandable metal stents, 39 by combined drainage method, 19 by tumor sphincterotomy and 6 by endoscopic fistulostomy. The successful rate of endoscopic procedure was 94.3%. The jaundice symptom was improved in 81.8% of the patients with a significant reduction of serum bilirubin in 64.7%. The complication after treatment occurred in 23 cases (2.6%), including cholangitis (23 cases), pancreatitis (8 cases), and bleeding (one case), and 3 cases were dead (0.2%). The median survival time of all patients was 14 months and life time analysis showed a life expectancy of 75.9%, 44.0% and 25.2% at 1, 2 and 3 years respectively. In the patients with MOJ secondary to pancreatobiliary malignancy, successful endoscopic drainage provides adequate relief of biliary obstruction and is associated with low morbidity and mortality. Endoscopic interventional treatment may be considered as an alternative of palliative biliary operation for the late stage of pancreatic and biliary malignancies.