Metallic biliary stenting versus surgery for palliation of inoperable distal malignant obstructive jaundice

Abstract

Background Pancreatic and biliary malignancies are rarely operable. The role of intervention is to palliate jaundice. Biliary drainage can be done by surgical bypass or biliary stenting either percutaneously or by endoscopic retrograde cholangiopancreatography. Plastic and expandable metal stents (EMS) are available.Aim To compare metallic biliary stenting versus surgery for palliation of inoperable malignant obstructive jaundice due to unresectable pancreatobiliary cancer.Patients and methods This retrospective, cohort study included 43 patients, presented by malignant obstructive jaundice due to unresectable pancreatobiliary cancer. They were divided into two groups: group I (20 patients) underwent palliative biliary-enteric surgical bypass; group II (23 patients) underwent endoscopic retrograde cholangiopancreatography and metal stent drainage.Results This study showed that both surgical bypass and EMS insertion have similar short-term satisfactory results in the control of jaundice. Surgical bypass had low incidence rate as regards late complications, although gastric outlet obstruction may occur for patients without gastric bypass. Despite EMS resulted in a shorter hospital stay, the higher late complications rate raised the cost, especially stent occlusion.Conclusion Endoscopic EMS and surgical bypass had similar results according to the efficacy of biliary drainage and mean survival period. EMS had a shorter hospital stay and fewer early complications. But, in the long run, surgical bypass results in less recurrent jaundice than the EMS but higher morbidity and mortality.