EXTRAHEPATIC BILIARY OBSTRUCTION BY METASTATIC GASTRIC-CARCINOMA

Forty-one patients with extrahepatic biliary obstruction by metastatic gastric carcinoma underwent retrospective study to determine demograp hics, clinical features, laboratory findings on presentation, time int erval from previous gastrectomy, level of biliary obstruction, methods of palliation, complications from treatment, treatment results, and s urvival. Thirty-seven patients underwent biliary decompression by perc utaneous transhepatic biliary drainage (PTBD) (35 patients), endoscopi c insertion of plastic stent (one patient), and operative insertion of T tube (1 patient). The remaining 4 patients had no biliary drainage procedure performed. Subsequently expandable metallic biliary stents w ere inserted in 9 patients through the PTBD tract. Two patients receiv ed postdrainage external irradiation. Reduction in serum total bilirub in was seen in all patients after drainage. Two patients were alive at the time of this analysis. The median survival of these 41 patients w as only 70 days. The 6- and 9-month survival rates were 27.0% and 9.7% , respectively. Hemoglobin (p < 0.001) and total bilirubin (p < 0.002) on presentation were found to be independent factors predicting survi val. Extrahepatic biliary obstruction by metastatic gastric carcinoma was associated with poor survival. Patients with profound anemia or ja undice on presentation carried the worst prognosis.