A randomized trial of endoscopic drainage methods for inoperable malignant strictures of the common bile duct☆,☆☆,★
Section snippets
Patients and methods
Between March 1993 and March 1995, 105 patients were included in the study. The inclusion criteria were as follows: jaundice secondary to a distal malignant common bile duct stricture with no previous attempts at biliary drainage; patient referral to one of two centers (Bicêtre Hospital or Edouard Herriot Hospital) for endoscopic palliation of jaundice; patient performance status of 0 (asymptomatic), 1 (symptomatic, fully ambulatory), or 2 (symptomatic, in bed less than 50% of day) after
Results
From March 1993 to March 1995, 105 patients were included in the study; four patients were excluded, three for failed endoprosthesis insertion and one in group 2 for not complying with the quarterly stent exchanges. Patient characteristics did not differ between groups (Table 3).
Empty Cell Group 1 Group 2 Group 3 p Value No. of patients 33 34 34 Mean age in years + SEM 73.3 + 13.2 74.5 + 11.0 71.9 + 13.4 NS (range) (39-92) (52-92) (39-95) Gender (M/F) 17/16 17/17 15/19 NS Percent weight loss + SEM 8 +
Discussion
This study is the first to compare the three main alternatives for endoscopic palliation of malignant jaundice. Our work partially supports the findings of two previous randomized studies comparing metal stents and plastic stents (with exchange for dysfunction).11, 12 Patients treated with a self-expanding metal stent develop fewer symptomatic biliary complications, have a longer symptom-free survival, undergo fewer ERCPs, and spend less time in the hospital than those treated with a plastic
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Cited by (0)
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From the Service des Maladies du Fole et de l'Appareil Digestif and INSERM U292, CHU de Bicêtre, Le Kremlin-Bicêtre; and the Département des Spécialités Digestives, Hopital Edouard Herriot, Lyon, France.
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Reprint requests: F. Prat, MD, PhD, Service des Maladies du Foie et de l'Appareil Digestif, CHU de Bicêtre, 78, rue du Général Leclerc, 94275 Le Kremlin-Bicêtre Cedex, France.
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