Palliation of distal malignant biliary obstruction: a selective approach

A retrospective study of 39 patients with inoperable distal malignant biliary obstruction (MBO) treated between March 2001 and March 2004 was conducted. There were 20 men and 19 women, and their mean age was 72 years. Eighteen patients were treated with hepatico-jejunostomy (bypass group) and 21 with metal stent (stent group). At the time of analysis, 32 patients died, and 7 were still alive. The median survival was 4.2 months. Thirty-day mortality, in-hospital morbidity, and recurrent jaundice were 10.3% (4/39), 10.3% (4/39), and 12.8% (5/39), respectively. Gastric outlet obstruction occurred in 3 (7.7%) patients before their death. The median survival in the bypass group was significantly longer than that in the stent group (7.2 versus 3.6 months; P = 0.01). The finding that bypass operation confers better survival compared with the metal stent in the treatment of inoperable distal MBO needs to be validated by a randomized controlled trial.