Abstract
Between January 1983 and December 1987, 103 patients who had hilar biliary obstruction (59 men, 44 women, median age 73 years) were referred to our institution. The causes of hilar biliary obstruction were carcinoma of the bile ducts (55), hepatic metastases or hepatocellular carcinoma (30), and carcinoma of the gallbladder (18). When endoscopic retrograde cholangiography was performed, the stricture was classified as type I in 28%, type II in 41%, and type III in 31% of the patients. In 92 patients, we tried to insert endoscopically a 10, 11, or 12 F Amsterdam type prosthesis; it proved possible in 66 (74%), and the prosthesis proved functional without further procedure in 49 cases (53%); no combined percutaneous and endoscopic method was used. At death or discharge, 45 patients (49%) had a successful drainage. Cholangitis was the main procedure-related complication and occurred in 25 patients. The 30-day mortality was 43%. Results varied according to type of stenosis: successful drainage was performed in 15% of the patients with type III stenosis, compared with 86% when the stenosis was of type I. Under a multivariate analysis the independent prognostic factors of 30-day mortality were: (1) development of infectious complications after endoscopic attempt at drainage (P<0.0001), and (2) absence of successful drainage (P<0.0001). In conclusion, endoscopic endoprosthesis placement allows a sufficient drainage in 53% of the cases. In type III stenosis, the high rate of 30-day mortality leads us the conclusion that endoscopic drainage must be avoided.
Similar content being viewed by others
References
Ferrucci JT Jr, Mueller PR, Harbin WP: Percutaneous transhepatic biliary drainage. Technique, results and applications. Radiology 135:1–13, 1980
Hatfield A, Tobias R, Terblanche S, Girwood AH, Fataar S, Harrie-Jones R, Kernoff L, Marks IN: Preoperative external biliary drainage in obstructive jaundice. A prospective controlled trial. Lancet 2:896–899, 1982
Cotton PB: Endoscopic methods for relief of malignant obstructive jaundice. World J Surg 8:854–861, 1984
Soehendra N, Reynders-Frederix V: Palliative bile duct drainage. A new endoscopic method of introducing a transpapillary drain. Endoscopy 12:8–11, 1990
Classen M, Hagenmuller F: Biliary drainage. Endoscopy 15:221–229, 1983
Deviere J, Baize M, Buset M, Cremer M: Complications of internal biliary drainage. Acta Endosc 16:19–29, 1986
Bismuth H, Corlette MB: Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet 140:170–178, 1975
Dixon WJ (ed): BMDP Statistical Software, Inc., University of California Press, California, 1981
Peto R, Pike MC, Armitage P: Design and analysis of randomized clinical trials requiring prolonged observations of each patients. Part II. Analysis and examples. Br J Cancer 35:1–39, 1977
Cox DR: Regression models and life tables. J R Stat Soc B 34:187–220, 1972
Polydorou A, Cairns SR, Dowsett J, Vaira D, Cotton PB, Salmon PR: Endoprosthesis for malignant liver hilum stricture; Report of 171 cases. Gut 29:A.726, 1988
Huibregtse K: Endoscopic biliary prostheses in bifurcation tumors.In Endoscopic Biliary and Pancreatic Drainage. K Huibregtse (ed). New York, George Thieme Verlag, 1988, pp 104–108
Deviere J, Baize M, De Toeve J, Cremer M: Long-term follow-up of patients with hilar malignant stricture treated by endoscopic internal biliary drainage. Gastrointest Endosc 34:95–101, 1988
Polydorou AA, Chisholm EM, Romanos AA, Dowsett JR, Cotton PB, Hatfield ARW, Russel RCG: A comparison of right versus left hepatic duct endoprosthesis insertion in malignant hilar biliary obstruction. Endoscopy 21:266–271, 1989
Deviere J, Motte S, Dumonceau JM, Serruys E, Thys JP, Cremer M: Risk factors for septicaemia after biliary endoprosthesis placement (BEP). Endoscopy, 20:79, 1988
Bonnel D, Ferrucci JT Jr, Mueller PR, Lacaine F, Peterson HF: Surgical and radiological decompression in malignant biliary obstruction: A retrospective study using multivariate risk factor analysis. Radiology 152:347–351, 1984
Dowsett JF, Vaira D, Hatfield ARW, Cairns SR, Polydorou A, Frost R, Croker J, Cotton PB, Russel RLS, Mason RR: Endoscopic biliary therapy using the combined percutaneous and endoscopic technique. Gastroenterology 96:1180–1186, 1989
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ducreux, M., Liguory, C., Lefebvre, J.F. et al. Management of malignant hilar biliary obstruction by endoscopy results and prognostic factors. Digest Dis Sci 37, 778–783 (1992). https://doi.org/10.1007/BF01296439
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01296439