Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice.

TLDR

The study compared survival, complications, hospitalization, and quality of life between endoscopic endoprosthesis and operative bypass in malignant obstructive jaundice. Fifty patients with malignant extrahepatic bile duct obstruction were randomized to endoscopic endoprosthesis (25) or operative bypass (25), with 19 of the surgical group actually receiving the anastomosis. Survival, complications, hospitalization, and quality of life did not differ between groups, indicating that endoscopic endoprosthesis is as effective as operative bypass.

Abstract

In patients with obstructive jaundice caused by malignant stricture of the extrahepatic bile duct we compared survival time, complication rates, hospitalisation requirements, and quality of life after palliation by endoscopic endoprosthesis or bypass surgery. During diagnostic endoscopic cholangiography 50 patients were randomised to the two treatment alternatives. All 25 patients randomised to endoprosthesis were treated by this procedure, whereas only 19 of 25 patients randomised to bypass surgery underwent operative biliary-digestive anastomosis. Life table analysis revealed no difference in survival between treatment groups or randomisation groups. No differences were found when other variables were compared. We conclude, that palliation of obstructive jaundice in malignant bile duct obstruction with endoscopically introduced endoprosthesis is as effective as operative bypass.