A minimally invasive palliative approach to advanced pancreatic and papillary cancer causing both biliary and duodenal obstruction.

BACKGROUND: In patients with both duodenal and biliary obstruction in whom endoscopic drainage is not feasible, the standard approach has been gastroenterostomy plus biliodigestive anastomosis. We present our results of percutaneous biliary drainage in combination with gastroenterostomy.

PATIENTS AND METHODS: Twenty-one patients, who received permanent percutaneous transhepatic biliary drainage (PTBD) and gastroenterostomy in case of symptomatic gastric outlet obstruction were retrospectively evaluated.

RESULTS: PTBD insertion succeeded in all patients; minor complications were encountered in 47.6% of cases. Bilirubin fell from 9.2 mg/dl (SD 7.6) to 4.9 mg/dl (SD 3.6). Gastroenterostomy, either open (n = 10) or laparoscopic (n = 6), had to be performed in 16 patients before, during or after PTBD. Thirty day mortality was 23.8%, not related to the procedure, but due to advanced neoplastic disease. Mean survival and hospital stay were 4.9 months (SD 3.6) and 21.5 days (SD 7.3) respectively.

CONCLUSIONS: The combination of PTBD and gastroenterostomy offers a promising alternative to surgery. However efforts to reduce complications as well as the duration of hospital stay are necessary.