Comparative analysis of metallic stenting versus surgical bypass in the management of malignant biliary obstruction

Abstract

Malignant obstructive jaundice is always encountered in advanced stage. Malignancies include Distal Bile duct Carcinoma, Ampulla of Vater Carcinoma, and Pancreas Carcinoma are sometimes impossible to cure and resect. Therefore, palliative treatments are the only way to relieve the disease for the patients to have a better quality of life in their remaining life- span. Available palliative treatments include stenting and surgical bypass. In our analysis, metallic stenting and double bypass composing hepaticojejunostomy and gastrojejunostomy are studied as they can be considered as the two most efficient palliative methods so far that are widely used in Hong Kong in the management of malignant biliary obstruction. The treatment options depends on both the physicians and the patient. However, patients are often on the horns of a dilemma when they are allowed to choose these palliative treatments.

This study hence aim to compare the cost-effectiveness of metallic stenting and surgical double bypass palliative treatment among five factors: 1) Number of hospital stay, 2) Re-admission rate, 3) Overall complication, 4) Change of bilirubin level and 5) Survival rate. A total of 40 patients data are being retrieved from the Queen Mary Hospital as 20 data are form the metallic stenting group, while the other 20 data are from surgical bypass.

After collecting the data and finishing the study, it was found that apart from a longer hospital stay, the surgical bypass patient group would generally have a lower re-admission and complication rate. While the parameters include bilirubin change before and after the treatment and the survival rate are not significantly different, which indicated these two parameters may not be the determining factors when deciding the treatment choice.

Based on the research outcome, surgical bypass may be a better choice of palliative treatment in the management of Malignant Biliary Obstruction that allows patients to obtain a better quality of life.