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A Comparison of Percutaneous, Endoscopic, and Operative Techniques

Janice G. Rothschild, MD; Marshall M. Kaplan, MD; Victor G. Millan, MD; Randolph B. Reinhold, MD

Arch Surg. 1989;124(5):556-560.

Abstract
• Surgery for obstructive jaundice is being challenged by endoscopic and percutaneous techniques. To compare their safety and efficacy, the courses of 157 patients treated for biliary obstruction were examined. Outcome was judged by mortality, complications, and need for further intervention. Forty-eight patients underwent endoscopic papillotomy (43 [90%] had stone disease) with two deaths and 11 cases of (23% incidence) of cholangitis. Pancreatitis developed in 9 (19%). Twenty-seven patients (56%) required further endoscopic, percutaneous, or surgical intervention. Sixty-five patients underwent transhepatic drainage (58 [89%] had malignant neoplasms) with a 28% (n = 18) mortality rate. Cholangitis developed in 26 (40%), and 50 (77%) required further transhepatic or surgical intervention. Forty-four patients underwent surgery (22 [50%] had stone disease and 12 [27%] had malignant neoplasms) with a 4.5% (n = 2) mortality rate. Cholangitis developed in 3 (7%), pancreatitis developed in 2 (4.5%), and bleeding developed in 1 (2%). Eight (18%) required further intervention. While endoscopic papillotomy provides efficacious treatment for stone disease, surgery provides a more expeditious, less morbid relief for malignant obstruction.

(Arch Surg. 1989;124:556-560)

Author Affiliations
From the Department of Surgery, New England Medical Center, Boston, Mass.

Footnotes
Accepted for publication December 28, 1988.

Read before the 69th Annual Meeting of the New England Surgical Society, Montreal, Canada, September 16, 1988.

Reprint requests to Department of Surgery, New England Medical Center, 750 Washington St, Boston, MA 02111 (Dr Rothschild).

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