PALLIATIVE ENDOSCOPIC DRAINAGE OF MALIGNA NT STRICTURES OF THE EXTRAHEPATIC BILIARY TREE

Between March 1982 and December 1987, 466 patients (256 women, 210 men , mean age 73 years) with tumor obstruction of the common bile duct we re referred to our department. The causes of obstruction were carcinom a of the pancreas (298 patients), carcinoma of the ampulla of Vater (3 2 patients) and carcinoma of the common bile duct (136 patients). Endo scopical insertion of a biliary prosthesis was initially possible in 3 77 patients (81 %). In case of failure, patients were referred to the radiologist for percutaneous drainage. Successful drainage was obtain ed in 58 patients with an overall success rate of 93 % (435 patients). Endoscopic replacement was necessary in 170 cases for 114 patients an d was successful in 155 (91 %). Pruritus was relieved in 89 % of the p atients. Serum bilirubin levels decreased more than 75 % after initial endoscopic endoprosthesis, repeated endoscopic endoprosthesis and per cutaneous prosthesis insertion in 80 %, 79 %, and 62 % of the patients , respectively. Short term complications of endoscopic endoprosthesis occurred in 28 % of patients with a mortality rate of 8 %. Percutaneou s prosthesis complications occurred in 33 % of patients with a mortali ty rate of 11 %. In the long term, cholangitis was the main complicati on and occurred in 27 % of patients with a delay of 103 +/- 105 days. Intestinal obstruction was observed in 7 % of patients. The average li fe expectancy of endoscopic endoprosthesis and percutaneous prosthesis was 109 +/- 157 and 92 +/- 101 days, respectively. The average life e xpectancy of patients was 163 +/- 224 days. Multivariate analysis reve aled that negative outcome was correlated with clinical pain, initial bilirubin level > 500 mumol/L, and increased, or a fall of less than 7 5 % in bilirubin levels after prosthetic implantation. In summary, end oscopic endoprosthesis or, in case of failure, drainage by percutaneou s prosthesis is possible in 93 % of patients with tumor obstruction of the common bile duct and provides adequate drainage in 80 % of cases. The mortality rate and complications are lower than in published surg ical data.