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Surgery or Endoscopy for Palliation of Biliary Obstruction Due to Metastatic Pancreatic Cancer
- Source :
- The American Journal of Gastroenterology. 101:2031-2037
- Publication Year :
- 2006
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2006.
-
Abstract
- Both endoscopic and surgical drainage procedures are effective palliative methods for malignant biliary obstruction. Surgical drainage is still preferred in developing countries due to the high cost of procuring metal biliary stents. The aim of this study was to evaluate the quality of life and the cost of care in patients with metastatic pancreatic cancer after endoscopic biliary drainage and surgical drainage.This is a prospective, randomized controlled trial conducted in a tertiary referral center in Brazil. Patients with biliary obstruction due to metastatic pancreatic cancer and liver metastasis, but without gastric outlet obstruction, were included in the study. Endoscopic biliary drainage with the insertion of a metal stent into the bile duct was compared with the surgical drainage procedure (choledochojejunostomy and gastrojejunostomy). Quality of life was assessed before, and 30 days, 60 days, and 120 days after the drainage procedure. The cost of drainage procedure, cost during the first 30 days and the total cost from drainage procedure to death were calculated.Of the 273 patients with pancreatic malignancy seen at our hospital between July 2001 and October 2004, 35 patients were eligible for the study, and 30 agreed to participate in the study. Both surgical and endoscopic drainage procedures were successful, without any mortality in the first 30 days. The cost of biliary drainage procedure (US dollars 2,832 +/- 519 vs 3,821 +/- 1,181, p= 0.031), the cost of care during the first 30 days after drainage (US dollars 3,122 +/- 877 vs 6,591 +/- 711, p= 0.001), and the overall total cost of care that included initial care and subsequent interventions and hospitalizations until death (US dollars 4,271+/- 2,411 vs 8,321 +/- 1,821, p= 0.0013) were lower in the endoscopy group compared with the surgical group. In addition, the quality of life scores were better in the endoscopy group at 30 days (p= 0.042) and 60 days (p= 0.05). There was no difference between the two groups in complication rate, readmissions for complications, and duration of survival.Endoscopic biliary drainage is cheaper and provides better quality of life in patients with biliary obstruction and metastatic pancreatic cancer.
- Subjects :
- Male
medicine.medical_specialty
Pancreatic disease
Palliative treatment
urologic and male genital diseases
Metastasis
Prosthesis Implantation
Metastatic pancreatic cancer
medicine
Humans
Prospective Studies
Prospective cohort study
Cholangiopancreatography, Endoscopic Retrograde
Cholestasis
Hepatology
medicine.diagnostic_test
business.industry
Liver Neoplasms
Palliative Care
Gastroenterology
Follow up studies
Middle Aged
medicine.disease
Surgery
Endoscopy
Pancreatic Neoplasms
Treatment Outcome
Biliary tract
Choledochostomy
Female
Stents
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 15720241 and 00029270
- Volume :
- 101
- Database :
- OpenAIRE
- Journal :
- The American Journal of Gastroenterology
- Accession number :
- edsair.doi.dedup.....200b9245637834b716509595965a2dcf