TITLE

RENDEZVOUS PROCEDURE OR PTC AND METAL STENT FOR BILIARY OBSTRUCTION—IMPLICATIONS FOR PROCEDURAL COSTS AND DURATION OR INPATIENT STAY

AUTHOR(S)
MacFaul, G.R.; Matthialagan, R.; Gibson, M.; Torrie, P.; Mee, A.S.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA87
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background and Aims: After Failed endoscopic treatment for malignant biliary obstruction, non-surgical approaches include a rendezvous (combined) procedure (CP) incorporating percutaneous cholangiography (PTC) then ERCP, or initial PTC and insertion of a metal stent. We hypothesised that PTC and stenting would lead to reduced procedural costs, morbidity, and duration of inpatient stay. Methods: Between 1994 and 1998 15 patients had a CP, and between 1998 and 2000 15 patients went onto PTC and stenting, following failed ERCP(s). Notes of both groups were analysed for diagnosis, duration of stay including delay from definitive procedure to discharge/death, and individual procedural costs. Results: Full data were available on 14 patients in each group. The average length of stay from first ERCP to discharge or death was 11.2 days (5-26) in the CP group, with a delay from CP to discharge of 4.7 days (1-19). Similar durations in the PTC group were 10.4 days (2-34) and 5.6 days (2-12), respectively. Average procedural costs were 1752 with CP (5 patients required two ERCPs prior to the CP) and 1548 for PTC and stenting. Average age was 71.8 years (41-89) and 78.5 years (55-94), respectively. Obstruction was due to proven pancreatic cancer in 86% of the CP group and 50% of the PTC group. Cholangiocarcinoma was found in 4 patients (26%) who had a metal stent. 2 patients from the CP group died (at 2 and 8 days) and 1 from the PTC group (day 5 post-PTC). Conclusion: PTC and metal stenting lead to decreased procedural costs and length of inpatient stay compared to the rendezvous procedure. It was also safely undertaken in a more elderly cohort of patients and we therefore suggest it should be the procedure of choice in the relief of malignant biliary obstruction after failed ERCP.
ACCESSION #
9747870

 

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