Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: A randomized trial

TLDR

In a randomized trial of 52 elderly patients with malignant distal common bile duct obstruction, 10‑French endoscopic biliary endoprostheses were compared with conventional surgical bypass, with groups matched and 51 patients followed to death. Endoscopic endoprosthesis shortened initial hospital stay, reduced total inpatient time despite more readmissions, achieved over 90 % jaundice relief, and yielded overall survival comparable to surgery, making it a valuable alternative.

Abstract

A total of 52 jaundiced elderly patients who had malignant obstruction of the distal common bile duct and who required palliative biliary decompression were randomized to receive either an endoscopically placed biliary endoprosthesis (10 French gauge) or conventional surgical bypass. Patients within the two treatment groups were well matched and 51 were followed until their death. Patients treated with endoprosthesis had a significantly shorter initial hospital stay than those treated surgically. In the long term, overall survival in the two groups was similar and jaundice was relieved in over 90 per cent of patients. Despite more re-admissions to hospital for those patients treated endoscopically, the total time spent in hospital still remained significantly shorter in this treatment group compared with those subjected to surgery. The endoscopically placed biliary endoprosthesis is a valuable alternative to conventional surgical bypass in the palliation of extrahepatic biliary obstruction.