Abstract
To examine the clinical applicability and complications of ERBD in malignant biliary obstructive diseases, 198 patients were entered into this study. Eighteen patients (9.1%) were not indicated for ERBD due to extensive cancerous invasion to the duodenum or Vater's papilla. Among the remaining 180 patients, ERBD was successfully done in 155 patients (86.1%) and was effective in 142 patients (91.6%) from May, 1983 to November, 1985. The most frequent cause of unsuccessful ERBD was inaccessibility of Vater's papilla because of unsuccessful EPT. Precut patillotomy was attempted on 24 of the 180 patients (13.3%) and was effective in 14 patients. Early complications within 7 days after ERBD occurred in 23 patients (12.8%). There were no deaths associated with early complications. In 84 patients on ERBD for more than 60 days, late complications occurred on 75 occasions in 46 patients (54.8%). Most frequent late complications were clogging (44 occasions in 23 patients : 27.4%) and cholangitis (24 occasions in 21 patients : 25%). Thirteen patients died of such complications, 5 of them dying suddenly at home approximately 3 months after ERBD probably due to biliary septic shock. It is necessary to clean the endoprosthesis immediately by ERC when cholangitis develops, as cholangitis sometimes leads to a cause of death. Functional lifetime of a 10Fr polyethylene endoprosthesis was 154±69 days (range : 77 to 394 days), which was not necessarily shorter than that of a 12Fr tube. The important thing, therefore, was that the endoprosthesis should be cleaned endoscopically every 2 to 3 months for preventing clogging of the endoprosthesis and for prolonging its functional lifetime. ERBD is a safe and effective noninvasive biliary drainage method and is indicated for all patients with malignant obstructive jaundice in whom ERCP and EPT can be performed.
