Treatment of malignant biliary obstruction by endoscopic implantation of iridium 192 using a new double lumen endoprosthesis.

Iridium 192 seeds contained in a ribbon were preloaded into a new double lumen 11 Fr endoprosthesis which was then inserted into malignant strictures of the bile duct and ampulla and left in place for 48 hours until 5000 rads were delivered to the tumor. The procedure was carried out in 14 patients (7 women, 7 men; mean age, 63.2 years; range, 46 to 86 years). Six patients were treated for cholangiocarcinomas, four with pancreatic carcinomas, and four with ampullary carcinomas. No complications occurred. The mean survival of the group was 7 months (range, 3 days to 27 months). This new technique provides both intraluminal brachytherapy and biliary drainage and is inserted intraduodenally across the papilla of Vater avoiding puncture of the liver and external hardware required by the percutaneous technique and hardware necessitated with a nasobiliary tube. Following removal of the iridium prosthesis, a large caliber endoprosthesis is inserted for continued decompression. Because of proven efficacy of endoprostheses, this new technique should be considered when intraluminal irradiation is indicated.