Endoscopic biliary drainage before pancreaticoduodenectomy for periampullary malignancies

Stuart G. Marcus, Michael Dobryansky, Peter Shamamian, Henry Cohen, Thomas H. Gouge, H. Leon Pachter, Kenneth Eng

Research output: Contribution to journalArticle

59 Scopus citations

Abstract

Despite decreased operative mortality, pancreaticoduodenectomy (PD) remains a formidable operation with substantial morbidity. We have evaluated the influence of preoperative endoscopic biliary drainage (EBD) on morbidity after PD for malignant biliary obstruction by retrospectively reviewing the medical records of 182 patients undergoing PD between April 1985 and August 1996. Of 52 study patients with malignant obstructive jaundice, 22 underwent preoperative EBD, and 30 were not drained. Eighty-three patients were excluded for bilirubin levels less than 5 mg/dl, 43 had other biliary drainage, and 4 had jaundice with benign pathology. Preoperative, intraoperative, and postoperative factors were compared. The two groups were well matched for clinical presentation and operative characteristics except for lower preoperative values of liver chemistries in patients undergoing EBD. Length of postoperative hospitalization for patients undergoing EBD was 13.5 days, compared with 19 days for patients who were not drained (p = 0.02). Patients who were not drained tended to have more overall complications (p = 0.054). Multivariate analysis revealed time to regular diet (p < 0.0001) and no preoperative drainage (p = 0.04) to be independent factors significantly increasing the length of hospitalization. Endoscopic biliary drainage before PD significantly reduced the length of postoperative hospitalization and was associated with less postoperative morbidity. Further studies, including cost analysis, are warranted.

Original languageEnglish (US)
Pages (from-to)125-129
Number of pages5
JournalJournal of clinical gastroenterology
Volume26
Issue number2
DOIs
StatePublished - Mar 1 1998

Keywords

  • Biliary drainage
  • Endoscopic retrograde cholangiopancreatography
  • Pancreatic cancer
  • Pancreaticoduodenectomy
  • Periampullary malignancies

ASJC Scopus subject areas

  • Gastroenterology

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