Stent or surgery for malignant low bile duct obstruction?

Ingemar Ihse,Eva Lindström,Lars-Erik Hammarström,Lars Hansson

doi:10.1155/1997/21935

Abstract

The development of non-surgical techniques for the relief of malignant low bileduct obstruction has cast doubt on the best way of relieving jaundice, particularly in patients fit for surgery whose life expectancy is more than a few weeks. We did a randomised prospective controlled trial comparing endoscopic stent insertion and surgical biliary bypass in patients with malignant low bileduct obstruction. 204 patients were randomised (surgery 103, stent 101); 3 subsequently proved to have benign disease and were excluded, leaving 101 surgical and 100 stented patients for assessment. Technical success was achieved in 94 surgical and 95 stent patients, with functional biliary decompression obtained in 92 patients in both groups. In stented patients, there was a lower procedure-related mortality (3% vs 14%, p=0.01), major complication rate (11% vs 29%, p=0.02), and median total hospital stay (20 vs 26 days, p=0.001). Recurrent jaundice occurred in 36 stented patients and 2 surgical patients. Late gastric outlet obstruction occurred in 17% of stented patients and 7% of the surgical group. Despite the early benefits of stenting there was no significant difference in overall survival between the two groups (median survival: surgical 26 weeks; stented 21 weeks; p=0.065). Endoscopic stenting and surgery are effective palliative treatments with the former having fewer early treatment-related complications and the latter fewer late complications.

Highlights

We did a randomised prospective controlled trial comparing endoscopic stent insertion and surgical biliary bypass in patients with malignant low bileduct obstruction. 204 patients were randomised; 3 subsequently proved to have benign disease and were excluded, leaving 101 surgical and 100 stented patients for assessment
They aimed at providing a basis for the One tentative reason for this could be that several ofthe patients to make fully informed decisions on whether their surgical bypasses were done in different referring hosjaundice should be relieved endoscopically or surgically. pitals outside the Middlesex, whereas the endoscopy
As pointed out above, the unexpectare generally published from expert centers and that even edly high early mortality rate after biliodigestive byhere the sensitivity obtained for different tests is far below pass does not do full justice to surgery, even if the statistics are correct

Summary

Introduction

We did a randomised prospective controlled trial comparing endoscopic stent insertion and surgical biliary bypass in patients with malignant low bileduct obstruction. 204 patients were randomised (surgery 103, stent 101); 3 subsequently proved to have benign disease and were excluded, leaving 101 surgical and 100 stented patients for assessment. Endoscopic treatment ofmalignant bile duct obstruction endoscopic treatment they die anyhow within one has become an accepted alternative to surgical month, questioning the advantages of endoscopy bilioenteric by-pass during the last decade.

Results

Conclusion