Percutaneous endoscopic gastrostomy/jejunostomy combined with percutaneous transhepatic biliary drainage in treating malignant biliary obstruction

Objective: To investigate the safety and efficacy of percutaneous endoscopic gastrostomy/jejunostomy (PEG/PEJ) combined with percutaneous transhepatic biliary drainage (PTCD) in treating malignant biliary obstruction. Subjects and Methods: Nine patients (6 males, average age 71.3±5.5 years) with complete obstruction of biliary tract were treated with PEG/PEJ after PTCD. The PEG/PEJ and PTCD tubes were linked outside of abdominal wall to direct the externally drained bile back to jejunum through the PEG/PEJ intestinal tube. Clinical symptoms and liver function were assessed following the treatment. Results: The operations were successfully completed in the 9 patients within in 40 min (average 35±2.9 min). Clinical symptoms, such as jaundice, abdominal distension, stomachache and diarrhea appear to be alleviated within 7 days of the operation. Serum levels of bilirubin, AST and ALT were reduced (P<0.01) 4 weeks following the treatment. There were no procedural complications. Concussions: Combined PEG/PEJ and PTCD appears to be safe and effective in the management of malignant biliary obstruction. Further, larger scale studies will be needed to verify findings of this report.