ENDOSCOPIC BILIARY STENTING IN A DISTRICT GENERAL-HOSPITAL

During a 48 month period to December 1990, 367 patients, median age 75 years, with obstructive jaundice caused by common bile duct stones (2 01), malignant biliary obstruction (148), and benign biliary stricture s (18), underwent therapeutic endoscopic retrograde cholangiopancreato graphy. Endoscopic biliary stenting and drainage was achieved in 333 o f 367 patients attempted (93%), seven patients requiring a combined pe rcutaneous endoscopic approach. Endoscopic stenting failed in 24 patie nts because of malignant duodenal infiltration (10), Billroth 2 gastre ctomy (6), tight and extensive biliary strictures (6), peripapillary d iverticulum (I), and technical failure (1). Prolonged follow up was av ailable in 91% (311 of 343). The 30 day mortality was 5% (17 of 343), which included two procedure related deaths (0.6%) from fulminant panc reatitis and major sphincterotomy site bleeding. Early complications o ccurred in 14% (48 of 343) and late complications occurred in 11.9% (3 5 of 294) patients, as of the original 343, 17 had died within 30 days and another 32 were lost to follow up. Eighty patients with incomplet e bile duct clearance and eight patients with benign biliary stricture s had biliary stents inserted for 12-48 months (median 30). Endoscopic biliary stenting services are necessary in a district general hospita l with technical success, death and morbidity rates comparable to othe r studies.