CHANGING ATTITUDES IN THE PALLIATION OF PROXIMAL MALIGNANT BILIARY OBSTRUCTION

The majority of patients with malignant hilar obstruction have an unre sectable tumor. Thus an effective palliation of obstructive jaundice i s the main therapeutic goal and can be achieved by either surgical or non-surgical procedures.One hundred twenty-nine consecutive patients w ith proximal biliary stricture, admitted to our institution, were retr ospectively reviewed. Thirty patients underwent surgical bypass, with 30-day mortality and morbidity rates of 10% and 23%, respectively. Med ian survival time was 41 weeks. Twenty-six patients were treated by pe rcutaneous stenting, with 30-day mortality and morbidity rates of 15% and 19%, respectively. Median survival time was 19 weeks. Endoscopic p alliation was performed in 73 patients, with 30-day mortality and morb idity rates of 5% and 18%, respectively. Median survival time was 27 w eeks. Although the differences among the three groups of patients were not statistically significant, a lower morbidity rate in patients tre ated by endoscopic stenting was shown.