Palliation of obstructive jaundice with a biliary endoprosthesis. Comparison of insertion by the percutaneous-transhepatic and the combined percutaneous-endoscopic routes.

Thirty-eight patients with obstructive jaundice due to inoperable malignancy were referred for insertion of an endoprosthesis. In 19 this was performed by the percutaneous-transhepatic route, and in 19 by a combined percutaneous-endoscopic approach. Satisfactory bile drainage was achieved in 15 patients after combined percutaneous-endoscopic insertion and in 11 after percutaneous-transhepatic prosthesis insertion. Cholangitis occurred after the combined approach in five patients and after percutaneous-transhepatic insertion in nine. None of these differences were significant. Thirty-day mortality rates and mean survival times were similar for each approach (26% and 10 weeks after combined insertion, 21% and 9 weeks after percutaneous-transhepatic). Prostheses inserted by the combined route were easily replaced when they occluded. This was not possible after percutaneous insertion. The combined percutaneous-endoscopic approach appeared to be better tolerated by the patients and is suggested as the method of choice in strictures which can not be intubated by the endoscopic route alone.