Palliative treatment of obstructive jaundice by transpapillary introduction of large bore bile duct endoprosthesis

The endoscopic techniques for introducing a large calibre (3.2 mm) biliary endoprosthesis to relieve jaundice are described. In 45 patients such an endoprosthesis was successfully introduced. The median survival time in 18 patients was 41 days (range three to 187). Twenty-six patients are still alive after a median of 28 days (range seven to 244). One patient had a surgical bypass after 24 days. Short-term complications were cholangitis and fever in 11 patients. Late complications were recurrent jaundice in four, upward migration of the endoprosthesis in two, and clogging of the endoprosthesis in one patient. The risk of cholangitis, which used to be a major problem with transpapillary introduced prostheses of smaller calibre, seems definitely diminished by using one with a large calibre.