Endoscopic palliation of malignant obstructive jaundice using resterilized accessories: an audit of success, complications, mortality and cost.

Abstract

OBJECTIVE:

To assess the success, complications and cost of endoscopic endoprosthesis placement for palliation of obstructive jaundice caused by malignancy.

METHODS:

Four hundred and two consecutive patients with obstructive jaundice due to nonresectable malignancy undergoing endoscopic stenting were studied. Commercial or home-made 7F or 10F endoprostheses were placed using minor modifications of the standard technique. The accessories were sterilized and reused.

RESULTS:

Endoprosthesis placement was successful in 291 patients (72.4%, 95% CI 67.7-76.7)-241 in one attempt, 49 in two attempts, and one in three attempts. Fifty nine patients (14.6%, 95% CI 11.4-18.6) had procedure-related complications, including cholangitis (30), pancreatitis (15), perforation (3) and bleeding (11). The incidence of cholangitis was significantly higher in bifurcation blocks than in other lesions (17.6% vs 4.7%, p = 0.0005). The success rate did not differ between distal and proximal lesions (68.1% vs 72.9%). The procedural cost per patient could be reduced from Rs 14,850 to Rs 6565 by reusing accessories after sterilization, and using home-made stents.

CONCLUSIONS:

Endoscopic endoprosthesis placement is a safe and effective method for palliation of malignant obstructive jaundice. Preparation of indigenous stents and reuse of accessories can reduce the cost of the procedure by over 50%.

• Authors: V S Swaroop, V Dhir, K M Mohandas, S D Wagle, K F Vazifdar, G Gopalakrishnan, O P Sharma, P Jagannath, L J Desouza
• Journal: Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology (Indian J Gastroenterol) Vol. 16 Issue 3 Pg. 91-3 (Jul 1997) ISSN: 0254-8860 [Print] India
• PMID: 9248178 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Cholestasis (complications, etiology, surgery)
• Cost-Benefit Analysis
• Endoscopy (adverse effects, economics, mortality)
• Female
• Gastrointestinal Neoplasms (complications, surgery)
• Humans
• Intraoperative Complications (epidemiology)
• Male
• Middle Aged
• Palliative Care
• Prosthesis Failure (economics)
• Retrospective Studies
• Safety
• Stents (adverse effects)
• Sterilization
• Survival Rate
• Treatment Outcome