Advertisement

Digestive Diseases and Sciences

, Volume 46, Issue 10, pp 2147–2153 | Cite as

Endoscopic Palliation and Survival in Malignant Biliary Obstruction

  • S.A. Weaver
  • B.S.F. Stacey
  • S.J. Hayward
  • G.J. Taylor
  • N.I. Rooney
  • D.A.F. Robertson
Article

Abstract

Malignant biliary obstruction is a common problem that is regarded as having a poor prognosis and is usually managed with palliation. Our aim was to investigate the survival of 182 consecutive subjects with malignant biliary obstruction where management was palliative within endoscopically placed biliary stent. We undertook a retrospective longitudinal study with date of death or confirmed survival of at least 23 months, as the primary end point. Diagnosis and blood indices from the 24 hr prior to first ERCP were obtained from hospital records. Of the 182 eligible subjects follow-up of date of death or confirmed survival of at least 23 months was obtained in 181 (99.5%). Of these 181 patients, 37 (20.4%) survived for more than one year. Histological confirmation was obtained in 47 of 182 subjects (25.8%). Increased age at first ERCP predicted increased survival (P < 0.05). In conclusion, in patients with malignant biliary obstruction, where management was endoscopic and palliative, 20.4% survived for more than one year with increased age at diagnosis being the only significant predictive marker.

ERCP malignant biliary obstruction stent survival palliation pancreatic carcinoma 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCE

  1. 1.
    Huibregtse K, Katon RM, Coene PP, Tytgat GN: Endoscopic palliative treatment in pancreatic cancer. Gastrointest Endosc 32:334–338, 1986Google Scholar
  2. 2.
    Siegel JH, Snady H: The significance of endoscopically placed prostheses in the management of biliary obstruction due to carcinoma of the pancreas: results of non-operative decompression in 277 patients. Am J Surg 81:634–641, 1986Google Scholar
  3. 3.
    Naggar E, Krag E, Matzen P: Endoscopically inserted biliary endoprosthesis in malignant obstructive jaundice. A survey of the literature. Liver 10:321–324, 1990Google Scholar
  4. 4.
    Soehendra N, Reijnders-Frederix V: Palliative duct drainage. A new endoscopic method of introducing a transpapillary drain. Endoscopy 12:8–11, 1980Google Scholar
  5. 5.
    Andersen JR, Sorensen SM, Kruse A, Rokkjaer M, Matzen P: Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice. Gut 30:1132–1135, 1989Google Scholar
  6. 6.
    Smith AC, Dowsett JF, Russell RC, Hatfield AR, Cotton PB: Randomised trial of endoscopic stenting versus surgical bypass in malignant low bile duct obstruction. Lancet 344:1655–1660, 1994Google Scholar
  7. 7.
    Speer AG, Cotton PB, Russell RC, et al: Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice. Lancet 2:57–62, 1987Google Scholar
  8. 8.
    Vitale GC, George M, McIntyre K, Larson GM, Wieman TJ: Endoscopic management of benign and malignant biliary strictures. Am J Surg 171:553–557, 1996Google Scholar
  9. 9.
    Shepherd HA, Royle G, Ross APR, Diba A, Arthur M, Colin-Jones D: Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: a randomised trial. B J Surg 75:1166–1168, 1988Google Scholar
  10. 10.
    Davids PH, Groen AK, Rauws EA, Tytgat GN, Huibregtse K: Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction [see comments]. Lancet 340:1488–1492, 1992Google Scholar
  11. 11.
    Knyrim K, Wagner HJ, Pausch J, Vakil N: A prospective, randomised, controlled trial of metal stents for malignant obstruction of the common bile duct. Endoscopy 25:207–212, 1993Google Scholar
  12. 12.
    Schmassmann A, Gunten EV, Knuchel J, Scheurer U, Fehr HF, Halter F: Wallstents versus plastic stents in malignant biliary obstruction: Effects of stent patency of the first and second stent on patient compliance and survival. J Gastroenterol 91:654–659, 1996Google Scholar
  13. 13.
    Yeoh KG, Zimmerman MJ, Cunningham JT, Cotton PB: Comparative costs of metal versus plastic biliary stent strategies for malignant obstructive jaundice by decision analysis. Gastrointest Endosc 49:466–471, 1999Google Scholar
  14. 14.
    Robertson DA, Ayres R, Hacking CN, Shepherd H, Birch S, Wright R: Experience with a combined percutaneous and endoscopic approach to stent insertion in malignant obstructive jaundice. Lancet 2:1449–1452, 1987Google Scholar
  15. 15.
    Mansfield JC, Griffin SM, Wadehra V, Matthewson K: A prospective evaluation of cytology from biliary strictures. Gut 40:671–677, 1997Google Scholar
  16. 16.
    Prat F, Chapat O, Ducot B, Ponchon T, Fritsch J, Choury AD, Pelletier G, Buffet C: Predictive factors for survival of patients with inoperable malignant distla biliary strictures: A practical management guideline. Gut 42:76–80, 1998Google Scholar
  17. 17.
    Bottger TC, Boddin J, Duber C, Heintz A, Kuchle R, Junginger T: Diagnosing and staging of pancreatic carcinoma-what is necessary? Oncology 55:122–129, 1998Google Scholar
  18. 18.
    Warshaw AL, Fernandez-del Castillo C: Pancreatic carcinoma. N Engl J Med 326:455–465, 1992Google Scholar
  19. 19.
    O'Brien S, Hatfield ARW, Craig PI, Williams SP: A three year follow-up of self expanding metal stents in the endoscopic palliation of longterm survivors with malignant biliary obstruction. Gut 36:618–621, 1995Google Scholar
  20. 20.
    Luman W, Cull A, Palmer KR: Quality of life in patients stented from malignant biliary obstruction. European J Gastroenterol Hepatol 9:481–484, 1997Google Scholar
  21. 21.
    Clarke BD, Lehman GA: “Cloggology” revisited: Endoscopic or surgical decompression of malignant biliary obstruction. Am J Gastroenterol 85:1533–1534, 1990Google Scholar
  22. 22.
    Coene PP, Groen AK, Cheng J, Out MM, Tytgat GN, Huibregtse K: Clogging of biliary endoprostheses: a new perspective. Gut 31:913–917, 1990Google Scholar
  23. 23.
    Christakis NA, Lamont EB: Extent and determinants of error in doctors' prognoses in terminally ill patients: Prospective cohort study. Bri Med J 320:469–473, 2000Google Scholar

Copyright information

© Plenum Publishing Corporation 2001

Authors and Affiliations

  • S.A. Weaver
    • 1
  • B.S.F. Stacey
    • 2
  • S.J. Hayward
    • 3
  • G.J. Taylor
    • 4
  • N.I. Rooney
    • 5
  • D.A.F. Robertson
    • 1
  1. 1.Department of GastroenterologyRoyal United HospitalBathUK
  2. 2.Department of GastroenterologySouthampton General HospitalSouthamptonUK
  3. 3.Department of RadiologyRoyal United HospitalBathUK
  4. 4.Reseach Development and Support UnitRoyal United HospitalBandUK
  5. 5.Department of HistopathologyRoyal United HospitalBathUK

Personalised recommendations