EAES Academy

Background
In patients suffering from distal biliary obstruction due to advanced periampullary cancer, the advantages of surgical bypass include high stent patency and low incidence of recurrent biliary obstruction. However, its use is limited due to the high invasiveness of the operation. Herein, we present the clinical findings of patients who underwent laparoscopic Roux-en-Y choledochojejunostomy (LRYCJ) compared with those who underwent endoscopic stent.
Material and Methods
From January 2015 to May 2021, we retrospectively reviewed the clinical outcomes of palliative care for malignant bile duct obstruction according to the type of intervention: LRYCJ versus endoscopic stenting. The occurrence of recurrent biliary obstruction (RBO) and clinical outcomes were reviewed, and the factors predisposing to RBO after initial intervention were identified via multiple regression analysis.
Results:

The final analysis included 28 patients treated with LRYCJ (22.4%) and 97 patients who underwent endoscopic stent (77.6%). The two groups did not differ in the incidence of early or late complications as well as mortality. However, the LRYCJ group showed a lower incidence of RBO (4 patients, 14.3% versus 73 patients, 75.3%, p < 0.001). As a predisposing factor for RBO, endoscopic stenting was the only highly significant predictor (OR 16.956, CI 5.140-55.935, p < 0.001).
Conclusions:
LRYCJ represents an attractive option for palliative treatment of malignant distal biliary obstruction, with improved biliary-tract patency and fewer subsequent interventions such as additional stenting, especially in cases with a relatively long life expectancy greater than 6 months.