BACKGROUND: A @entity1 with unresectable periampullary malignancy found at laparotomy has traditionally received a prophylactic double bypass (biliary and duodenal), associated with considerable morbidity. With modern endoscopic treatments, a surgical bypass has become questionable. This study aims to compare the two strategies. Sahlgrenska University Hospital (SU) performs a double bypass (DoB) routinely, and Sk  ne University Hospital Lund (SUL) secures biliary drainage endoscopically and treats only symptomatic @entity9727 (Wait and See, WaS). METHOD: Between 2004 and 2013, 73 @entity1 from SU and 70 from SUL were retrospectively identified. Demographics, @entity5 -related factors and post-operative outcomes during the remaining lifetime of the @entity1 were noted. RESULTS: The DoB group had significantly more complications (67% versus 31%, P = 0.00002) and a longer hospital stay (14 versus 8 days, P = 0.001) than the WaS group. The two groups had a similar proportion of @entity1 in need of readmission. The DoB @entity1 and the WaS @entity1 with metallic biliary stents were comparable regarding their need of re-interventions and hospitalization as a result of @entity253 . A surgical duodenal bypass did not prevent future @entity9727 . CONCLUSION: @entity1 with unresectable periampullary malignancies can safely be managed with endoscopic drainage on demand and with a lower morbidity and a shorter hospital stay than with a surgical prophylactic bypass.

A wait-and-see strategy with subsequent self-expanding metal stent on demand is superior to prophylactic bypass surgery for unresectable XXXX .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity253 :: ('MESH:D001660', 'Disease') :: ['biliary obstruction'] @entity9727 :: ('MESH:D004380', 'Disease') :: ['duodenal obstruction', 'duodenal obstructions'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumour']
@entity5 :: (MESH:D009369,Disease) :: ['periampullary cancer']
