[Placement of stent for bile drainage by using combined percutaneous and endoscopic technique]

44 patients with malignant biliary obstruction underwent attempted placement of stent for bile drainage by using a combined percutaneous transhepatic and endoscopic transpapillary approach (combined procedure). In all the patients endoscopic procedures had failed and there were contraindications for surgery. The initial procedure was percutaneous transhepatic access to the biliary tree. The bile duct was drained externally for three days before the combined procedure. Combined procedure was performed in these 44 cases and successful in 37 (84.1%). The procedure-related morbidity and 30-day mortality were 46.7% and 16.7% respectively for lower common bile duct obstruction and 50.0% and 21.4% for hepatic hilus obstruction. The total morbidity and 30-day mortality were 47.7% and 18.2% respectively. The combined procedure extends the use of endoscopy and offers nonsurgical therapy for patients with malignant biliary obstruction.