Drainage by endoscopic endoprosthesis in biliary obstruction. A report of initial experience

Biliary drainage by endoscopic, transpapillary insertion of endoprosthesis was attempted in 38 patients with obstructive jaundice and was successful in 25. The procedure was palliative in 17 cases and preoperative in eight. Benefit was obtained by ten of the former and seven of the latter patients, while in eight the serum bilirubin did not fall despite adequate catheterization. In two intubated patients with recurrent nonterminal jaundice, the endoprostheses were repeatedly changed; the median time to clogging was 51 (8-77) days. Cholangitis developed in 15 of the total 38 patients. Antibiotic prophylaxis, though not routinely used, is recommended for all cases with biliary stasis. Unimpeded bile flow was not ensured with 7 F endoprostheses, whose patency time tended to be short. By using sizes 10-12 F the authors hope to improve bile flow, thereby diminishing obstruction, stagnation and infection and prolonging patency. In selected cases the method may offer an alternative to the percutaneous approach, and possibly also to surgical bypass.