Malignant Biliary Obstruction: Clinical Outcome of Endoscopic Intervention - An Experience of Tertiary Centers

Most patients with malignant obstructive jaundice present at a stage when they are beyond the scope of curative surgery. Endoscopic stenting is the approach of choice worldwide to improve quality of life and survival of such patients. The aim of this study was to find out overall clinical outcome of endoscopic intervention in malignant obstructive jaundice. This prospective study done in two tertiary gastroenterology centers in Dhaka included consecutively admitted 79 adult patients with malignant biliary obstruction for endoscopic stenting, followed by a follow-up period of six months. Outcome evaluation included success rate of stenting and drainage, complications, and mortality rate at one-month, and survival up to six-months. ERCP revealed carcinoma of pancreas, periampullary carcinoma, cholangiocarcinoma, carcinoma of gallbladder, and metastasis in the biliary trees in 22 (27.8%), 22 (27.8%), 20 (25.3%), 11 (13.9%), and 04 (5.1%) cases respectively. Successful stenting and drainage could be achieved in 62 (78.5%) and 58 (73.4%) cases. Stent blockage (23.9%) and cholangitis (19.4%) were the main complications. Total death at one-month was nine of 55 (16.4%), and 21 (38.2%) patients survived up to six-months, with no difference in one-month mortality rate among the malignancies (P 0.05). Stenting prolonged six-month (88.2%) and mean survival (121.2±67.7 days) only in patients with periampullary carcinoma (P 0.001). Endoscopic stenting can safely be done in malignant biliary obstruction to offer palliation with an outcome, which is not unsatisfactory.