With the advent of advanced endoscopic techniques, the management of malignant obstructive jaundice has changed over the past decade. Nonoperative biliary drainage techniques have replaced surgical drainage procedures as the mainstay for palliation of pancreatic cancer. Nonoperative hiliary intervention for obstructive jaundice was first developed via the transhepatic route, although this approach was associated with all the problems of puncturing the liver, particularly bile leakage and bleeding . More recently, with the development of larger channel, side-viewing endoscopes , biliary stent placement via the endoscope has provided good decompression with a much lower incidence of complications  . A randomized controlled trial from the Middlesex Hospital in 1989 compared surgical bypass and endoscopic stenting in over 200 patients . In this study, both young and elderly patients were included and the two groups were well balanced with equal numbers of elderly and ill patients in each group in an attempt to study a realistic spectnim of patients, a point of critique of many previous studies.
KeywordsPancreatic Cancer Common Bile Duct Primary Biliary Cirrhosis Obstructive Jaundice Endoscopic Stenting
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