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World J Gastrointest Endosc. Jan 16, 2010; 2(1): 10-14
Published online Jan 16, 2010. doi: 10.4253/wjge.v2.i1.10
Operable malignant jaundice: To stent or not to stent before the operation?
Rungsun Rerknimitr, Pinit Kullavanijaya
Rungsun Rerknimitr, Pinit Kullavanijaya, Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok 10310, Thailand
Author contributions: Rerknimitr R reviewed the literature and wrote the paper; Kullavanijaya P commented on and reviewed the paper.
Correspondence to: Rungsun Rerknimitr, MD, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10310, Thailand.
Telephone: +66-2-2564265 Fax: +66-2-2527839
Received: May 20, 2009
Revised: August 26, 2009
Accepted: September 2, 2009
Published online: January 16, 2010

Traditionally, pre-operative biliary drainage (PBD) was believed to improve multi-organ dysfunction, and for this reason, was practiced worldwide. Over the last decade, this concept was challenged by many reports, including meta-analyses that showed no difference in morbidity and mortality between surgery with, and surgery without PBD, in operable malignant jaundice. The main disadvantages of PBD are seen to be the additional cost of the procedure itself, and the need for longer hospitalization. In addition, many studies showed the significance of specific complications resulting from PBD, such as recurrent jaundice, cholangitis, pancreatitis, cutaneous fistula, and bleeding. However, the results of these studies remain inconclusive as to date there has been no perfect study that equally randomized comparable patients according to the level of obstruction and technique used for PBD. Generally, endoscopic stent insertion (ES) is preferred for common duct obstruction, whereas endoscopic nasobiliary drainage and percutaneous biliary drainage is reserved for hilar obstruction, since ES in hilar block confers a high rate of cholangitis. Although, there is no guideline which either supports or refutes this approach, certain subgroups of patients, including those with symptomatic jaundice, cholangitis, impending renal failure, hilar block requiring preoperative portal vein embolization, and those who need pre-operative neoadjuvant therapy, are suitable candidates for PBD.

Keywords: Biliary drainage, Surgery, Complication, Mobidity, Mortality