This study was conducted on a total 52 patients, who required palliative biliary decompression for obstructive jaundice due to unresectable cancer ofthe head ofthe pancreas orperiampullary region.·Patients were randomized into two groups for palliation by conventional surgical bypass procedure or endoscopic endoprostheses. Patients within the two treatment groups werefollowed until their death. They were compared as regards survival time, early mortality, complication rates, hospitalization requirements qfter 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 successjUlly by the other procedure.
I 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 surgically.
This was balanced by more frequent hospital readmission. their total time spent in hospital was still less but without statistically significant difference. Late morbidity was significantly higher in the endoprosthetic treated group in comparison to surgically treated group (33.3 % versus 7.1% respectively) due to frequent blockage of the en40prostheses causing recurrent attacks ofjaundice and cholangitis. In short-term survivors, the higher late morbidity rates after endoprostheses were offset by the higher early morbidity rates and longer initial hospital stay qfter surgical
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 i$ effective as operative bypass for palliation ofobstructive 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 endoprostheses had a late signijIcant morbidity caused by recurrent blockage ofthe prostheses with consequent recurrent cholangitis andjaundice that required hospital readmission and impair the quality of life. Endoscopic endoprostheses is the optimal technique for palliation of jaundice for short-term survivors. |
