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Air cholangiogram is not inferior to dye cholangiogram for malignant hilar biliary obstruction: A randomized study of efficacy and safety

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Abstract

Background

Endoscopic biliary drainage is the palliative treatment of choice in patients with malignant hilar biliary obstruction. Contrast injection can lead to cholangitis, whereas air cholangiography may have a lesser incidence of cholangitis.

Objective

The objective of the present study is to prospectively compare the efficacy and safety of air vs. dye cholangiogram in malignant hilar biliary obstruction.

Methods

Patients with type II and III malignant hilar biliary stricture were included in a prospectively randomized manner at a tertiary care center. Unilateral self-expanding metal stent was placed in patients with a malignant hilar block using either air or dye as a contrast medium. Outcome measures were successful deployment, successful drainage, early complications, and procedure-related and 30-day mortality.

Results

Forty-nine patients were randomized to air cholangiogram (25 patients, group A) or dye cholangiogram (24 patients, group B). Most of the patients had type II stricture (19 in group A and 20 in group B). Successful stenting and drainage were achieved in 25 (100 %) and 24 (96 %) in group A and 23 (95.8 %) and 22 (91.6 %) (p = ns), respectively. Cholangitis developed in 1 (4 %) and 4 (16.6 %) in group A and B, respectively (p < 0.05). There was no procedure-related or 30-day mortality.

Conclusion

Use of air cholangiography was as safe and as effective as dye cholangiography in patients with malignant hilar biliary obstruction, and it decreased the risk of post-ERCP cholangitis.

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Acknowledgments

None.

Conflict of interest

RS, RP, NSC, AM, and PKJ all declare that they have no conflict of interest.

Ethics statement

The authors declare that the study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning Human and Animal Rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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Authors and Affiliations

  1. Medanta Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India

    Randhir Sud, Rajesh Puri & Narendra S. Choudhary

  2. Department of Gastroenterology, Geetanjali Medical College, Hiranmagri Extension, Manwakhera, NH-8 Bypass, Near Eklingpura Chouraha, Udaipur, 313 002, India

    Ashish Mehta

  3. Department of Gastroenterology, Bangalore Medical College, Rajaram Mohan Roy Road, Ambedkar Veedhi, Sampangi Rama Nagar, Bengaluru, 560 002, India

    Parvesh Kumar Jain

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  1. Randhir Sud
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  2. Rajesh Puri
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  3. Narendra S. Choudhary
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  4. Ashish Mehta
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  5. Parvesh Kumar Jain
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Correspondence to Rajesh Puri.

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Sud, R., Puri, R., Choudhary, N.S. et al. Air cholangiogram is not inferior to dye cholangiogram for malignant hilar biliary obstruction: A randomized study of efficacy and safety. Indian J Gastroenterol 33, 537–542 (2014). https://doi.org/10.1007/s12664-014-0516-5

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  • DOI: https://doi.org/10.1007/s12664-014-0516-5

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