Affecting 8-10 patients per 100 000 population, pancreatic cancer is the primary cause of malignant obstructive jaundice and is the presenting feature in over three quarters of these patients. Unfortunately, using modern imaging techniques, such as endoscopic ultrasound or pancreatic protocol computed tomography with vascular reconstruction, 80%-90% prove unrespectable for cure. Historically, this jaundice was treated surgically with biliary bypass. Over the past 10 years, however, multiple studies have shown comparable palliation (3-6 month survival) with percutaneous or endoscopic placement of polyethylene prostheses. Moreover, our group, as well as others, have shown that despite comparable survivals, resource utilization (costs) to time of death for the endoscopic group are approximately one-half of those expended in surgically treated patients.
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