Endoscopic palliation of malignant obstructive jaundice using resterilized accessories: an audit of success, complications, mortality and cost.

Santhi Swaroop Vege, V. Dhir, K. M. Mohandas, S. D. Wagle, K. F. Vazifdar, G. Gopalakrishnan, O. P. Sharma, P. Jagannath, L. J. Desouza

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: To assess the success, complications and cost of endoscopic endoprosthesis placement for palliation of obstructive jaundice caused by malignancy. METHODS: Four hundred and two consecutive patients with obstructive jaundice due to nonresectable malignancy undergoing endoscopic stenting were studied. Commercial or home-made 7F or 10F endoprostheses were placed using minor modifications of the standard technique. The accessories were sterilized and reused. RESULTS: Endoprosthesis placement was successful in 291 patients (72.4%, 95% CI 67.7-76.7)-241 in one attempt, 49 in two attempts, and one in three attempts. Fifty nine patients (14.6%, 95% CI 11.4-18.6) had procedure-related complications, including cholangitis (30), pancreatitis (15), perforation (3) and bleeding (11). The incidence of cholangitis was significantly higher in bifurcation blocks than in other lesions (17.6% vs 4.7%, p = 0.0005). The success rate did not differ between distal and proximal lesions (68.1% vs 72.9%). The procedural cost per patient could be reduced from Rs 14,850 to Rs 6565 by reusing accessories after sterilization, and using home-made stents. CONCLUSIONS: Endoscopic endoprosthesis placement is a safe and effective method for palliation of malignant obstructive jaundice. Preparation of indigenous stents and reuse of accessories can reduce the cost of the procedure by over 50%.

Original languageEnglish (US)
Pages (from-to)91-93
Number of pages3
JournalIndian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
Volume16
Issue number3
StatePublished - Jul 1997
Externally publishedYes

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Obstructive Jaundice
Costs and Cost Analysis
Cholangitis
Mortality
Stents
Pancreatitis
Neoplasms
Hemorrhage
Incidence

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Endoscopic palliation of malignant obstructive jaundice using resterilized accessories : an audit of success, complications, mortality and cost. / Vege, Santhi Swaroop; Dhir, V.; Mohandas, K. M.; Wagle, S. D.; Vazifdar, K. F.; Gopalakrishnan, G.; Sharma, O. P.; Jagannath, P.; Desouza, L. J.

In: Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology, Vol. 16, No. 3, 07.1997, p. 91-93.

Research output: Contribution to journalArticle

Vege, Santhi Swaroop ; Dhir, V. ; Mohandas, K. M. ; Wagle, S. D. ; Vazifdar, K. F. ; Gopalakrishnan, G. ; Sharma, O. P. ; Jagannath, P. ; Desouza, L. J. / Endoscopic palliation of malignant obstructive jaundice using resterilized accessories : an audit of success, complications, mortality and cost. In: Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology. 1997 ; Vol. 16, No. 3. pp. 91-93.
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abstract = "OBJECTIVE: To assess the success, complications and cost of endoscopic endoprosthesis placement for palliation of obstructive jaundice caused by malignancy. METHODS: Four hundred and two consecutive patients with obstructive jaundice due to nonresectable malignancy undergoing endoscopic stenting were studied. Commercial or home-made 7F or 10F endoprostheses were placed using minor modifications of the standard technique. The accessories were sterilized and reused. RESULTS: Endoprosthesis placement was successful in 291 patients (72.4{\%}, 95{\%} CI 67.7-76.7)-241 in one attempt, 49 in two attempts, and one in three attempts. Fifty nine patients (14.6{\%}, 95{\%} CI 11.4-18.6) had procedure-related complications, including cholangitis (30), pancreatitis (15), perforation (3) and bleeding (11). The incidence of cholangitis was significantly higher in bifurcation blocks than in other lesions (17.6{\%} vs 4.7{\%}, p = 0.0005). The success rate did not differ between distal and proximal lesions (68.1{\%} vs 72.9{\%}). The procedural cost per patient could be reduced from Rs 14,850 to Rs 6565 by reusing accessories after sterilization, and using home-made stents. CONCLUSIONS: Endoscopic endoprosthesis placement is a safe and effective method for palliation of malignant obstructive jaundice. Preparation of indigenous stents and reuse of accessories can reduce the cost of the procedure by over 50{\%}.",
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AU - Mohandas, K. M.

AU - Wagle, S. D.

AU - Vazifdar, K. F.

AU - Gopalakrishnan, G.

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N2 - OBJECTIVE: To assess the success, complications and cost of endoscopic endoprosthesis placement for palliation of obstructive jaundice caused by malignancy. METHODS: Four hundred and two consecutive patients with obstructive jaundice due to nonresectable malignancy undergoing endoscopic stenting were studied. Commercial or home-made 7F or 10F endoprostheses were placed using minor modifications of the standard technique. The accessories were sterilized and reused. RESULTS: Endoprosthesis placement was successful in 291 patients (72.4%, 95% CI 67.7-76.7)-241 in one attempt, 49 in two attempts, and one in three attempts. Fifty nine patients (14.6%, 95% CI 11.4-18.6) had procedure-related complications, including cholangitis (30), pancreatitis (15), perforation (3) and bleeding (11). The incidence of cholangitis was significantly higher in bifurcation blocks than in other lesions (17.6% vs 4.7%, p = 0.0005). The success rate did not differ between distal and proximal lesions (68.1% vs 72.9%). The procedural cost per patient could be reduced from Rs 14,850 to Rs 6565 by reusing accessories after sterilization, and using home-made stents. CONCLUSIONS: Endoscopic endoprosthesis placement is a safe and effective method for palliation of malignant obstructive jaundice. Preparation of indigenous stents and reuse of accessories can reduce the cost of the procedure by over 50%.

AB - OBJECTIVE: To assess the success, complications and cost of endoscopic endoprosthesis placement for palliation of obstructive jaundice caused by malignancy. METHODS: Four hundred and two consecutive patients with obstructive jaundice due to nonresectable malignancy undergoing endoscopic stenting were studied. Commercial or home-made 7F or 10F endoprostheses were placed using minor modifications of the standard technique. The accessories were sterilized and reused. RESULTS: Endoprosthesis placement was successful in 291 patients (72.4%, 95% CI 67.7-76.7)-241 in one attempt, 49 in two attempts, and one in three attempts. Fifty nine patients (14.6%, 95% CI 11.4-18.6) had procedure-related complications, including cholangitis (30), pancreatitis (15), perforation (3) and bleeding (11). The incidence of cholangitis was significantly higher in bifurcation blocks than in other lesions (17.6% vs 4.7%, p = 0.0005). The success rate did not differ between distal and proximal lesions (68.1% vs 72.9%). The procedural cost per patient could be reduced from Rs 14,850 to Rs 6565 by reusing accessories after sterilization, and using home-made stents. CONCLUSIONS: Endoscopic endoprosthesis placement is a safe and effective method for palliation of malignant obstructive jaundice. Preparation of indigenous stents and reuse of accessories can reduce the cost of the procedure by over 50%.

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