A group of 107 patients with unresectable carcinoma of the pancreas who underwent simultaneous biliary bypass and gastroenterostomy were compared with a group of 107 matched patients who underwent biliary bypass only. Hospital mortality was identical. A longer hospital stay was evident after concomitant gastroenterostomy and was related to problems with delayed gastric emptying. However, the patients with this complication had preoperative signs or symptoms suggestive of partial or impending duodenal obstruction. Notably, eight of 53 patients with adequate follow-up data after biliary bypass alone required gastroenterostomy within nine months because of duodenal obstruction. Results of our experience suggest that patients with a favorable prognosis who undergo palliative biliary bypass for carcinoma of the pancreas should also undergo a gastroenterostomy.
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