Document Detail

Combined percutaneous and endoscopic procedures for bile duct obstruction: simultaneous and delayed techniques compared.
MedLine Citation:
PMID:  12845949     Owner:  NLM     Status:  MEDLINE    
BACKGROUND/AIMS: In patients with obstructive jaundice, when the endoscopic approach fails to achieve biliary drainage, percutaneous cannulation and combined endoscopic/percutaneous endoprosthesis insertion can be performed simultaneously or in stages. This study compared these two approaches. METHODOLOGY: Over a three-year period 41 patients were studied. All had obstructive jaundice for which endoscopic drainage had failed. In 22 patients (group 1) percutaneous transhepatic drainage was followed a few days later by combined endoscopic and percutaneous procedure. In 19 patients (group 2) the percutaneous transhepatic drainage and combined drainage were performed at the same session. In the multiple stage group the mean interval between the first endoscopic retrograde cholangiopancreatography and final combined procedure was 9 days (SD 5.2). The groups were similar for sex, underlying pathology and reasons for failure of endoscopic approach. Group 1 patients were older 73 vs. 65 years (p < 0.05). RESULTS: Patients in group 2 had a more rapid recovery and discharge home: mean 6 days, compared to mean 18 days from the initial procedure for group 1 (p < 0.001). Five patients died of their disease without leaving hospital (4 in group 1, 1 in group 2). In each group drainage failed in 1 patient. Complications were more common in group 1: 73% vs. 37% (p < 0.05). Pancreatitis (3 vs. 2) and septicemia (4 in group 1, 3 in group 2) were similar but group 1 had complications from the external drain: cholangitis and pyrexia in 4 patients, 3 bile leaks, and 1 catheter displacement. CONCLUSIONS: When endoscopic drainage alone fails, a combined percutaneous/endoscopic procedure should only be performed if it can be carried out simultaneously.
J Wayman; J C Mansfield; K Matthewson; D L Richardson; S M Griffin
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Hepato-gastroenterology     Volume:  50     ISSN:  0172-6390     ISO Abbreviation:  Hepatogastroenterology     Publication Date:    2003 Jul-Aug
Date Detail:
Created Date:  2003-07-08     Completed Date:  2003-10-08     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8007849     Medline TA:  Hepatogastroenterology     Country:  Greece    
Other Details:
Languages:  eng     Pagination:  915-8     Citation Subset:  IM    
Medical and Surgical Endoscopy Unit, Radiology Department, Royal Victoria Infirmary Newcastle upon Tyne, UK.
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MeSH Terms
Aged, 80 and over
Cholangiopancreatography, Endoscopic Retrograde
Cholestasis / etiology,  surgery*
Digestive System Surgical Procedures*
Middle Aged
Retrospective Studies
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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