Introduction Palliative biliary stenting has been practiced widely to treat symptomatic patients with non-resectable pancreatic carcinoma and other forms of cancers obstructing the biliary system. We have undertaken this study to assess the outcome of this practice in these patients especially who are on end of life care and to assess whether biliary interventions on occasions cause or hasten death.
Methods We retrospectively studied 160 consecutive patients who had ERCP (Endoscopic Retrograde CholangioPancreatography) from October 2010 to October 2011 at Clinical Diagnostic Unit, Queen's Hospital, Romford, London. Data were collected using Scorpio data (GI reporting tool) on demographic variables, aetiology, type of cancer, Patients symptomatology pre and post procedure, Liver function tests (Cyberlab), complications secondary to ERCP, 30-day mortality post ERCP.
Results Of the 160 ERCP patients, 12 (7.5%) had 30-day mortality post ERCP. One patient could not be stented due to technical reasons. Of the 12 patients 11 had Metastatic Ca that is, Pancreas (5), Breast (2), Oesophagus (1), Cholangiocarcinoma (1), Lung (1), unknown primary (1). Of the cancer patients 6 (11) were male and 5 (11) were female with a mean age of 70.7 years. Seven of those patients had a presenting complaint of severe abdominal pain not fully controlled with opiates, all 11 (11) patients had varying degree of deranged liver function tests predominantly cholestatic picture, 3 (11) patients had SIRS (Systemic Inflammatory Response Syndrome). Technical failure to place the stent occurred in 1patient. Post ERCP 6 (11) were symptomatically better on discharge, 4 (11) had worsening of their symptoms, Baseline bilirubin was 213 μmol/l with 7 days post ERCP bloods showed improvement with mean bilirubin of 73 μmol/l in four patients (11), ALP of 6 (11) and conversely rest of the patients showed worsening LFT's. 30 days mortality showed four patients died in hospital, two in hospice and five at home. All three patients with SIRS died within 1-week post ERCP.
Conclusion Malignant biliary obstruction has significant mortality. Identification of patients with SIRS is important as these patients have very high mortality and may not improve from ERCP and biliary interventions. Older age >65 years and more advanced disease were related with higher mortality despite interventions. This series suggest better selection of patients for biliary interventions in advanced metastatic cancers.
Competing interests None declared.