J Korean Med Sci.  2012 Apr;27(4):356-362. 10.3346/jkms.2012.27.4.356.

Comparison of Clinical Outcome and Cost-Effectiveness after Various Preoperative Biliary Drainage Methods in Periampullary Cancer with Obstructive Jaundice

• Hong SK
• Jang JY
• Kang MJ
• Han IW
• Kim SW

• KMID: 2157894
• DOI: http://doi.org/10.3346/jkms.2012.27.4.356

Abstract

The aim of this study was to compare the clinical outcome and cost-effectiveness of preoperative biliary drainage (BD) methods in periampullary cancer, and to suggest guidelines for selecting the appropriate preoperative BD method. Between October 2004 and August 2010, 211 patients underwent pancreatoduodenectomy after preoperative BD. Clinical outcome and cost-effectiveness of the preoperative BD methods were compared based on the final drainage method used and on intention-to-treat analysis. There was no significant difference in drainage duration between percutaneous transhepatic biliary drainage (PTBD) and endoscopic BD groups (14.2 vs 16.6 days, respectively; P = 0.121) but daily diminution of serum bilirubin level was higher in the PTBD group (0.7 vs 0.6 mg/dL/day, respectively; P = 0.041). Based on intention-to-treat analysis, drainage duration was shorter (13.2 vs 16.5 days, respectively; P = 0.049), daily diminution of serum bilirubin level was higher (0.7 vs 0.6 mg/dL/day, respectively; P = 0.041). Medical care cost was lower (14.2 vs 15.7 x 10(3) USD, respectively; P = 0.040) in the PTBD group than in the endoscopic BD group. When selecting the preoperative BD method, practitioners should consider that PTBD is more cost-effective and safer than endoscopic BD.

Keyword

Drainage; Biliary Cancer; Jaundice; Preoperative; Pancreatoduodenectomy

MeSH Terms

Aged
Bilirubin/blood
Common Bile Duct Neoplasms/complications/economics/*surgery
Cost-Benefit Analysis
*Drainage
Female
Humans
Jaundice, Obstructive/complications/*diagnosis
Male
Middle Aged
Pancreatic Neoplasms/complications/economics/*surgery
Pancreaticoduodenectomy
Postoperative Complications
Preoperative Care/*economics
Retrospective Studies
Time Factors
Treatment Outcome

Figure

• 

  Fig. 1 A graph of bilirubin decline pattern in the endoscopic BD groups. ERBD, endoscopic retrograde biliary drainage; ENBD, endoscopic naso-biliary drainage.

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