Relief of malignant obstructive jaundice by percutaneous insertion of a permanent prosthesis in the biliary tree.

Twelve patients with malignant obstruction of the biliary tree were treated by dilating the lesion percutaneously and inserting an internal large-bore teflon prosthesis in place bridging the the stricture. All 12 patients had unresectable neoplasms. The procedure was devised because existing modes of palliation using surgical techniques are associated with significant mortality or mobidity. There are also many problems with nonsurgical catheter drainage. Decompression was achieved in all 12 patients as shown radiographically by passage of contrast into the duodenum. Disappearance of pruitus was achieved in seven of seven patients, and in 10 of 12 disappearance of jaundice (bilirubin, before prosthesis, 18.4 +/- 4.5 mg/dl [mean +/- 1 SD], bilirubin 1 month after prosthesis, 1.8 +/- 0.6 mg/dl [mean +/- 1 SD], P less than 0.001) with improvement of general clinical status was achieved. Percutaneous placement of a permanent biliary tract prosthesis is safe and effective for the palliative decompression of malignant biliary tract obstruction.