Both endoscopic and surgical drainage procedures are effective palliative methods for malignant biliary obstruction.
Surgical drainage is still preferred in developing countries due to the high cost of procuring metal biliary stents.
Dr Gottumukkala Raju and colleagues from Texas evaluated quality of life and cost of care in metastatic pancreatic cancer after endoscopic biliary vs surgical drainage.
The research team conducted a prospective, randomized controlled trial in a tertiary referral center in Brazil.
|Hospitalizations until death were lower in the endoscopy group|
|American Journal of Gastroenterology|
Patients with biliary obstruction due to metastatic pancreatic cancer and liver metastasis, but without gastric outlet obstruction, were included in the study.
Endoscopic biliary drainage with the insertion of a metal stent into the bile duct, a procedure known as choledochojejunostomy was assessed.
The researchers compared this technique to the surgical drainage procedure known as gastrojejunostomy.
The team evaluated quality of life before, and 30 days, 60 days, and 120 days after the drainage procedure.
The cost of drainage procedure, cost during the first 30 days and the total cost from drainage procedure to death were calculated.
Of the 273 patients with pancreatic malignancy seen at our hospital between 2001 and 2004, 35 patients were eligible for the study.
The research team reported that 30 agreed to participate in the study.
The team found that both surgical and endoscopic drainage procedures were successful, without any mortality in the first 30 days.
The cost of biliary drainage procedure, and the cost of care during the first 30 days after drainage was lower in the endoscopy group.
The team noted that overall cost of care, including initial care and subsequent interventions and hospitalizations until death were lower in the endoscopy group.
In addition, the researchers observed that the quality of life scores were better in the endoscopy group at 30 days, and 60 days.
There was no difference between the 2 groups in complication rate, readmissions for complications, and duration of survival.
Dr Raju's team concludes, “Endoscopic biliary drainage is cheaper and provides better quality of life in patients with biliary obstruction and metastatic pancreatic cancer.”