Biliary enteric bypass for malignant obstruction

A retrospective review was conducted on patients with malignant biliary obstruction and their management by either percutaneous transhepatic biliary drainage (PTHD) (16 patients) or by biliary enteric bypass (BEB) (17 patients). Patients were similar in respect to clinical staging. There was a significantly greater time of palliation (time out of the hospital) for the group treated by BEB and also a significant reduction in death from sepsis, although there was no difference in ultimate survival. Patients whose obstruction was unrelieved by PTHD were successfully treated by BEB. The type of initial management (PTHD or BEB) was apparently a function to which service the patient was originally admitted. Fourteen of 16 PTHD patients were originally admitted to the medical service, while 15/17 BEB treated patients were originally admitted to the surgical service. It appeared from this review that septic deaths and time out of the hospital could be better provided by BEB compared to PTHD.