Experience with a combined percutaneous and endoscopic approach to stent insertion in malignant obstructive jaundice.

A non-operative method of palliation in malignant obstructive jaundice was used in 14 patients in whom a biliary stent could not be placed endoscopically. A guide wire was manipulated through the obstructing lesion through the percutaneous transhepatic route and retrieved through an endoscope. The stent was then fed through the endoscope over the guide wire and across the biliary stricture. There were no early complications, and worth-while palliation was obtained in most cases. The success rate for placing an endoscopic stent increased in this unit from 69 to 97% with the introduction of this technique.