Effectiveness of a new approach to minimally invasive surgery in palliative treatment of patients with distal malignant biliary obstruction

Figure 1 Patient randomization based on the bile duct decompression techniques used in the study. AC: Ampullary cancer; CC: Cholangiocarcinoma; ERBS: Endoscopic retrograde biliary stenting; IETBD: Internal-external transpapillary biliary drainage; IJBED: Internal-external biliary-jejunal drainage; MN: Metastatic nodes; PC: Pancreatic cancer; PTBD: Percutaneous transhepatic biliary drainage.

Figure 2  Layout of external-internal biliary-jejunal drainage placement.

Figure 3 Kaplan-Meier cumulative survival curves for patients with distal malignant biliary obstruction who underwent various minimally invasive palliative procedures. Patients with internal-external biliary-jejunal drainage had a higher survival rate than the other groups (P < 0.05). DMBO: Distal malignant biliary obstruction; ERBS: Endoscopic retrograde biliary stenting; IEBJD: Internal-external biliary-jejunal drainage; IETBD: Internal-external transpapillary biliary drainage; PTBD: Percutaneous transhepatic biliary drainage.

Figure 4 Kaplan-Meier cumulative survival curves for patients with internal-external transpapillary biliary drainage and endoscopic retrograde biliary stenting depending on the presence of cholangitis episodes. Patients with cholangitis had a lower survival rate compared to those without (P < 0.05). ERBS: Endoscopic retrograde biliary stenting; IETBD: Internal-external transpapillary biliary drainage.

Figure 5 Barium X-ray examination of the stomach and duodenum in a patient 3 mo after external-internal biliary-jejunal drainage for pancreatic head cancer. Contrast reflux in the bile duct is absent. IEBJD: Internal-external biliary-jejunal drainage.