Endoscopic palliation of obstructive jaundice by inoperable pancreatic cancer: Personal experience
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Abstract
AIM OF THE STUDY: Few patients with pancreatic cancer are eligible for resection. In the remainder, estimation of prognosis is important to optimise various aspects of care, including palliation of biliary obstruction and trial of chemotherapy. The aim is to refer our personal experience about the palliation with endoscopic stenting in patients with unresectable pancreatic cancer.
METHODS: The Authors reviewed retrospectively 132 patients affected by unresectable pancreatic cancer who underwent palliative interventions with endoscopic stenting from 2000 to 2004.
RESULTS: Jaundice dramatically decreased in 86% of patients within 36 hours, in 12% within 48 hours and in 2% after two days.
As complication were registered 3% of bleeding after endoscopic sphyncterotomy, 2% mild acute pancreatitis after-ERCP and in 7% of patients transitory hyperamylasemia.
The most frequent late complication was relapse of jaundice or cholangitis for stent clogging (51%) in a variable range from 72.3 to 120.7 days, treated with stent substitution.
No mortality ERCP-related was registered.
CONCLUSION: Resection offers the only potentially curative approach to pancreatic cancer. The majority of patients are either too old, too ill with coexistent disease, or have a tumour that is undoubtedly inappropriate to resect. Thus for the vast majority an endoprosthesis to relieve the jaundice, is the preferred management, after a multidisciplinary approach.