Dec 17, 1994

Randomised trial of endoscopic stenting versus surgical bypass in malignant low bileduct obstruction

Lancet
A C SmithP B Cotton

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 stented 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: surg...Continue Reading

Mentioned in this Paper

Endoscopy (Procedure)
Yellow Skin or Eyes (Symptom)
Surgical Endoscopy
Stent, Device
Bile Duct Carcinoma
Obstruction
Malignant Paraganglionic Neoplasm
Cholestasis
Complication
Jaundice, Hemolytic

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