Endoscopic palliative treatment in pancreatic cancer

Patients with carcinoma of the head of the pancreas will develop obstructive jaundice at some point in their course in 80% to 90% of the cases. Surgical biliary digestive anastomosis carries a high 30-day mortality (20%), and hospitalization may be prolonged for several weeks owing to postoperative morbidity. We attempted endoscopic endoprosthesis placement in 221 patients with pancreatic carcinoma for palliation of obstructive jaundice. The procedure was successful in 200 of 221 (90%) with a procedure-related mortality of only 2% and a 30-day mortality of 10%. The serum bilirubin level normalized in 92% of those who survived, and the mean survival of 6 months is comparable to that achieved with biliodigestive anastomosis. Early cholangitis (8%) and late clogging of the endoprosthesis (21% at a mean of 5 months) are problem areas that need to be improved. We believe these results justify considering endoscopic biliary prosthesis as the treatment of choice in nonresectable jaundiced patients with carcinoma of the head of the pancreas.