BACKGROUND: The British Society of Gastroenterology guidelines for the management of malignant obstructive jaundice state: "If a stent is placed prior to surgery, this should be of the plastic type and it should be placed endoscopically. Self-expanding metal stents should not be inserted in patients who are likely to proceed to resection." In 2003, a small series of complications after endoscopic intervention caused a change in the authors' practice. Currently, all patients requiring relief of biliary obstruction before surgical resection undergo attempted insertion of a short metal biliary stent. METHODS: Retrospective analysis of the authors' prospective database containing all patients presenting with periampullary and pancreatic tumors between January 2004 and May 2008 was performed. RESULTS: The authors have attempted percutaneous placement of internal metal stents in 67 patients with resectable malignancies and biliary obstruction. Stenting was successful for 53 patients (79%), and 5 patients (9.4%) experienced complications. These five patients were successfully managed conservatively, and all proceeded to trial dissection. The mean bilirubin level was 253 mg/dl before intervention and 33 mg/dl before surgery for the stented patients compared with 308 mg/dl before intervention and 102 mg/dl before surgery for those who needed external drainage. CONCLUSIONS: Percutaneous insertion of short metal stents provides a safe and effective alternative to endoscopic stent placement for treating jaundice preoperatively in patients with potentially resectable tumors around the pancreatic head.
BACKGROUND: The British Society of Gastroenterology guidelines for the management of malignant obstructive jaundice state: "If a stent is placed prior to surgery, this should be of the plastic type and it should be placed endoscopically. Self-expanding metal stents should not be inserted in patients who are likely to proceed to resection." In 2003, a small series of complications after endoscopic intervention caused a change in the authors' practice. Currently, all patients requiring relief of biliary obstruction before surgical resection undergo attempted insertion of a short metal biliary stent. METHODS: Retrospective analysis of the authors' prospective database containing all patients presenting with periampullary and pancreatic tumors between January 2004 and May 2008 was performed. RESULTS: The authors have attempted percutaneous placement of internal metal stents in 67 patients with resectable malignancies and biliary obstruction. Stenting was successful for 53 patients (79%), and 5 patients (9.4%) experienced complications. These five patients were successfully managed conservatively, and all proceeded to trial dissection. The mean bilirubin level was 253 mg/dl before intervention and 33 mg/dl before surgery for the stented patients compared with 308 mg/dl before intervention and 102 mg/dl before surgery for those who needed external drainage. CONCLUSIONS: Percutaneous insertion of short metal stents provides a safe and effective alternative to endoscopic stent placement for treating jaundice preoperatively in patients with potentially resectable tumors around the pancreatic head.
Authors: John T Mullen; Jeffrey H Lee; Henry F Gomez; William A Ross; Norio Fukami; Robert A Wolff; Eddie K Abdalla; Jean-Nicolas Vauthey; Jeffrey E Lee; Peter W T Pisters; Douglas B Evans Journal: J Gastrointest Surg Date: 2005-11 Impact factor: 3.452
Authors: Christopher Lawrence; Douglas A Howell; Donald E Conklin; Andreas M Stefan; Ronald F Martin Journal: Gastrointest Endosc Date: 2006-05 Impact factor: 9.427
Authors: H Gerke; R White; M F Byrne; H Stiffier; R M Mitchell; H I Hurwitz; M A Morse; M S Branch; P S Jowell; B Czito; B Clary; T N Pappas; D S Tyler; J Baillie Journal: Dig Liver Dis Date: 2004-06 Impact factor: 4.088
Authors: J H Klinkenbijl; J Jeekel; P I Schmitz; P A Rombout; G A Nix; H A Bruining; M van Blankenstein Journal: Br J Surg Date: 1993-12 Impact factor: 6.939