engleski

Treatment of malignant biliary obstruction

Peri-ampullary region is a common site for carcinoma, arising from diverse structures with different prognosis but similar effect. Once the diagnose of a malignant biliary obstruction (MBO) is established, tumour staging is essential to determine whether the tumour is resectable or not. Pancreatico-duodenectomy is the only potentially curable treatment. For patients judged unfit for curative resection, palliative treatment must be considered. The choice lies between surgical bypass and endoscopic or percutaneous transhepatic insertion of a plastic or metal mesh expandable endoprosthesis (stent). In jaundiced patients with duodenal obstruction, surgery is necessary. Otherwise, any method can be used, with decision depending on clinical situation and method available. Endoscopic stent insertion is successful in up to 95% of patients and has a lower procedure-related mortality, major complication rate, and hospital stay than surgical bypass, but recurrent jaundice and late gastric outlet obstruction occur more often, and despite the early benefits of stenting there is no significant difference in overall survival. Percutaneous stent insertion has a similar postprocedural complications, early mortality and mean survival time as palliative surgery. Endoscopic stent insertion is the standard procedure used in our department, with 80 stents inserted to 53 patients with MBO in the period from 1995-1999. It has a significantly higher success rate and a lower early mortality than the percutaneous route. With all the treatment options now available, no patient with MBO should die jaundiced or with intolerable itching.

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