Management of Obstructive Jaundice in Patients with Periampullary Tumors in a Covid-19 Pandemic Situation

ABSTRACT

Introduction: The redistribution of hospital resources secondary to SARS-CoV-2(COVID19) produced a reduction and delay in surgical activity. Analysis of the management of obstructive jaundice (OI) in a reference centre during COVID19 in patients with potentially resectable periampullary tumours. Method(s) Observational study, limited to the year 2021, on the management of OI in periampullary pathology. Analysis of the different biliary drainage (BD) techniques (endoscopic/transhepatic) and the associated complications. The indication criteria for BD were bilirubin levels >10 mg/dl, cholangitis or expectation of surgery >2 weeks from inclusion on the waiting list. Patients with criteria of unresectability or those with neoadjuvant indication were excluded from the study. Result(s) Thirty-five patients were analyzed, with an age range between 45-80 years, who were indicated to undergo a pancreaticoduodenectomy. 51% of these patients required preoperative DB. DB was performed endoscopically (ERCP) in 10 patients and by transparietohepatic approach (TPHD) in 8 patients. In endoscopic approach the majority of stents used were expandable coated metallic (eight patients). The most frequent complications associated with ERCP were cholangitis and acute cholecystitis. The most frequent complication associated with TPHD was cholangitis. Conclusion(s) Preoperative BD associates a greater number of perioperative complications. At present, there is consensus in avoiding preoperative DB, except in cases with cholangitis or hyperbilirubinemia. If DB is necessary, the endoscopic approach (ERCP) would be indicated. Coated Metal stents should be considered for patients with resectable pancreatic cancer, especially if surgery is not immediate.