Role of Palliative Endoscopic Drainage in Patients with Malignant Biliary Obstruction

Abstract

Background: Endoscopic biliary drainage for malignant obstructive jaundice is a viable palliative alternative, but its role and cost-effectiveness compared to percutaneous drainage or surgical bypass are subject to debate. Aim: To review the evidence in the literature with regard to the settings in which endoscopic drainage favorably compares with and affords palliation and quality of life comparable to percutaneous drainage or surgical bypass in malignant obstructive jaundice patients. Method: Using PubMed, Embase, Current Contents, and Medline, a literature search was performed for papers published from 1979 to April 2004. All retrieved papers comparing endoscopic drainage with percutaneous or surgical drainage, with special reference to the level of obstruction, were rated according to the strength of evidence and carefully analyzed. Results and Conclusions: Palliative drainage affords improved quality of life. The outcome of endoscopic and percutaneous drainage was similar, but data were few and inconsistent. Due to fewer late complications, surgical bypass is an alternative to metal stents (Wallstent™) which remain patent longer than plastic stents (large-bore polyethylene), with an overall median of 180 and 109 days, respectively, in patients who survive longer than about 6 months, which cannot be accurately predicted though. Overall early and late morbidity, stent patency, and survival were similar in patients treated for hilar compared to distal obstruction.

Metallic or Plastic Stent for Bile Duct Obstruction in Ampullary Cancer?

“…Metallic stents have a longer patency (6-12 months average patency for metallic stents versus 3-4 months for plastic stents) because of larger diameters compared with plastic stents [13]. Stent patency is an important factor because it affects patient quality of life and medical costs [14]. Therefore, metallic stents are advocated in patients with life expectancy greater than 6 months.…”

Cholangitis prevention in endoscopic Klatskin tumor palliation: air cholangiography technique

“…The end point is improving in quality of life [20][21][22]. ERCP and stenting is the palliative treatment of choice for inoperable Klatskin patients [3,5,6,10].…”

“…Post-ERCP cholangitis occurred specially after cannulation, and incomplete drainage of a bile duct was injected [11]. The goal of this study was not to analyze if plastic stent is better than self-expandable metallic stents neither if two stents are better than only one neither how many liver volume is necessary to drain to achieve improvement in quality of life [22,23]. Thus, we always used plastic stents in the present study.…”

Gallengangskarzinom: Update neuer Stents zur Palliation

“…Metallstents sind in ihrer Platzierung technisch anspruchsvoller, sie gewährleisten einen sofortigen Drainageeffekt und sie weisen unbeschichtet mit 5-8 Monaten eine doppelt so lange Funktionsdauer wie Plastikstents auf [6,7]. Die Komplikationsrate ist primär niedrig, im Langzeitverlauf aber hoch (25-55%) [8].…”

“…Die erfolgreiche Implantation von Metallendoprothesen gewährleistet in der Regel die beste Lebensqualität [7,12].…”