[Endoscopic transpapillary bile duct drainage in malignant obstructive jaundice]

Endoscopic biliary duct drainage was performed in 54 patients with obstructive jaundice caused by papillary carcinoma (n = 4), periampullar carcinoma (n = 4), carcinoma of head of pancreas (n = 16), primary biliary duct carcinoma (n = 14), biliary bladder carcinoma (n = 14) and hilar lymph node metastases (n = 2) using a bilioduodenal endoprosthesis. Drainage was successful in 45 cases; serum bilirubin decreased rapidly, well-being improved, appetite and weight increased. The average survival time was 4.8 months. The initially high rate of complications, mainly due to cholangitis, with a mortality rate of 9.3% could be reduced drastically after use of a duodenoscope with a 3.7 mm bore instrumentation canal enabling insertion of well-draining wide-lumen endoprostheses. Drainage should only be used in non-resectable tumours, general inoperability or for preoperative relief of biliary ducts in jaundice and prospective curative surgical intervention. As results improve with mounting experience it may be expected that endoscopic biliary duct drainage will replace palliative surgery, especially in elderly patients at risk.