The evaluation of the effects of endoscopic biliary drainage on clinical, laboratory and survival parameters of proximal and distal type malignant biliary obstructions

In this thesis study, we aimed to evaluate biochemical changes and survival using a classification depending on placement of malignant biliary obstructions endoscopic biliary stent application. We included 161 cases which had endoscopic biliary drainage (EBD). Patients are divided into two groups. 54 of the patients had proximal obstruction, while 107 of them had distal obstruction. The biochemical success of biliary drainage procedure is higher in distal obstruction when compared to the proximal ones (p=0,037). At proximal obstruction biliary stent application, complication rates were also higher (p=0,002). Stent application after 30 days survival rate were higher in the distal obstruction groups (p=0,02). On the other hand a subgroup of malignant obstruction patients in whom tumour were unresectable and plastic stents were used during the procedure, comparision of proximal obstruction with the distal ones did not reveal meaningful difference in terms of survival rate (p>0.05). Meaningfully high ratio of having percutaneous transhepatic biliary drainage (PTBD) procedures at the proximal obstructions after stent application have been found (p=0.001). EBD are found to be more efficient and have lower complication ratios at distal malignant biliary obstructions when compared to the proximal ones. Accepting the fact that this study is retrospective and have deficiencies to determine the optimum approach for proximal malignant obstruction of biliary system we believe it is necessarry to make prospective, randomized studies with more patients which include a endoscopic bilateral plastic stent application, metalic stent applications and PTBD procedures, all together, and compare their success and survival results.