A MINIMALLY INVASIVE PALLIATIVE APPROACH TO ADVANCED PANCREATIC AND PAPILLARY CANCER-CAUSING BOTH BILIARY AND DUODENAL OBSTRUCTION

Background: In patients with both duodenal and biliary obstruction in whom endoscopic drainage is not feasible, the standard approach has be en gastroenterostomy plus biliodigestive anastomosis, We present our r esults of percutaneous biliary drainage in combination with gastroente rostomy. Patients and methods: Twenty-one patients, who received perma nent percutaneous transhepatic biliary drainage (PTBD) and gastroenter ostomy in case of symptomatic gastric outlet obstruction were retrospe ctively evaluated. Results: PTBD insertion succeeded in all patients; minor complications were encountered in 47.6% oi cases. Bilirubin fell from 9.2 mg/dl (SD 7.6) to 4.9 mg/dl (SD 3.6). Gastroenterostomy, eit her open (n = 10) or laparoscopic (n = 6), had to be performed in 16 p atients before. during or after PTBD. Thirty day mortality was 23.8%, not related to the procedure, but due to advanced neoplastic disease. Mean survival and hospital stay were 4.9 months (SD 3.6) and 21.5 days (SD 7.3) respectively. Conclusions: The combination of PTBD and gastr oenterostomy offers a promising alternative to surgery. However effort s to reduce complications as well as the duration of hospital stay are necessary.