[Endoscopic stent or surgical bypass? A review and evidence-based comparison of palliative procedures in inoperable pancreas tumours].

This review summarises the data of current meta-analyses on the outcome of endoscopic and surgical biliary bypass procedures applied for inoperable pancreatic tumours. The authors suggest that plastic biliary stents should be used in cases only with short survival (less than six months). In patients with a prognosis of longer than six month, self-expandable metal stents are more cost-effective. This latter technique is as efficient as the traditional surgical bypass procedures. However, surgical bypass is preferable in cases if tumour resection is questionable after staging or in patients with gastric emptying problems.Furthermore, application of duodenal stents is suggested in selected cases only due to relatively frequent late complications (stent migration, perforation, obstruction). Duodenal stents can be used in patients with advanced stage disease or very high operative risk.