A RATIONAL APPROACH TOWARD OPTIMAL PALLIATION USING ENDOSCOPIC ENDOPROSTHESES VERSUS OPERATIVE BYPASS IN OBSTRUCTIVE JAUNDICE BY ADVANCED PANCREATIC CANCER
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This study was conducted on a total 52 patients, who required pallia tive biliary decompression for obstructive jaundice due to urtresectabie cancer of the head of the pancreas or periampullary region. Patients were randomized into two groups for palliation by conventional surgical by pass procedure or endoscopic endoprostheses. Patients within the two treatment groups were followed until their death. They were compared as regards survival time, early mortality, complication rates, hospttalization requirements after palliation. The technical success rate in the surgical drainage procedure was 92.3% versus 84.6 % for the endoprosthetic treated group. Failed cases were managed successfully by the other pro cedure. There was no significant difference in the periprocedural mortality and the overall survival in the two groups. Patients treated with endoprosthe ses had a significantly shorter initial hospital stay than those treated sur gically. This was balanced by more frequent hospital readmission, their total time spent in hospital was still less but without statistically signifi cant difference. Late morbidity was significantly higher in the endopros thetic treated group in comparison to surgically treated group (33.3 % ver sus 7.1% respectively) due to frequent blockage of the endoprostheses causing recurrent attacks offaundice and cholangitis. In short-term survi vors, the higher late morbidity rates after endoprostheses were offset by the higher early morbidity rates and longer initial hospital stay after sur gical bypass. In long-term survivors, there was also a significant increase in the late morbidity after endoprostheses with no significant difference in early morbidity rates in either treatment group. We concluded that endoprothesis is effective as operative bypass for palliation of obstructive jaundice in cancer head of the pancreas or periampullary region, both procedures are alternative to each other in case of failed one technique. We suggest surgery for long-term survivors as endo prostheses had a late significant morbidity caused by recurrent blockage of the prostheses with consequent recurrent cholangitis andjaundice that required hospital readirussion and impair the quality of life. Endascopic endoprostheses is the optimal technique for palliation of jaundice for short-term survivors.