ENDOSCOPIC METALLIC STENTING VERSUS SURGICAL BYPASS IN CASES OF INOPERABLE PANCREATIC HEAD CARCINOMA

Aim: To compare endoscopic metallic stenting with surgical bypass in palliation of patients with inoperable pancreatic head carcinoma. Methods: This prospective study included consecutive patients with obstructive jaundice due to inoperable pancreatic head carcinoma that were admitted to The Department of General Surgery, Minia University Hospital between July 2007 and September 2008. Results: Endoscopic stenting was successful in 14 of 15 patients (93.3%) of the endoscopy group. The mean bilirubin level decreased from 25.1±11.3mg before the procedure to 5±2.1mg/dL at the 4 weeks follow-up, and this difference was statistically significant (Paired t test, P 0.0001). Surgical bypass was successful in 14 of 15 patients (93.3). The mean bilirubin level decreased from 26.1±10.1 mg before the procedure to 4±2.7 mg/dL at the 4 weeks follow-up, and this difference was statistically significant (Paired t test; P=0.0001). The mean procedural time was 45±15 minutes in endoscopy group, and 90±39 minutes in surgical group (t test, P=0.0003). The mean hospital stay was 3±1 days in endoscopy group versus 7 ±3 days in surgical group (t test, P=0.0001). The mean ICU stay was 2.1±1.4 in endoscopy group versus 5.4±2.9 days in surgical group (t test, P=0.0005). The mean cost of endoscopic stenting was 4000 ± 300 LE in the endoscopy group versus 2600 ± 200 LE in the surgical group (t test, P=0.0001). The mean of morbidity rate was 3.2±1.4 in endoscopy group versus 7.4±3.2 in the surgical group (t test, P=0.0001). Conclusion: Both endoscopic metallic stenting and surgical therapies are equally effective in term of palliation of obstructive jaundice. Endoscopic drainage is characterized by low procedure time, short hospital stay and low morbidity. However, it is associated with high cost