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Comparing the efficacy of initial percutaneous transhepatic biliary drainage and endoscopic retrograde cholangiopancreatography with stenting for relief of biliary obstruction in unresectable cholangiocarcinoma

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Abstract

Background

In patients with cholangiocarcinoma (CC), management of biliary obstruction commonly involves either up-front percutaneous transhepatic biliary drainage (PTBD) or initial endoscopic retrograde cholangiopancreatography (ERCP) with stent placement. The objective of the study was to compare the efficacy and of initial ERCP with stent placement with efficacy of initial PTBD in management of biliary obstruction in CC.

Methods

A single-center database of patients with unresectable CC treated between 2006 and 2017 was queried for patients with biliary obstruction who underwent either PTBD or ERCP. Groups were compared with respect to patient, tumor, procedure, and outcome variables.

Results

Of 87 patients with unresectable CC and biliary obstruction, 69 (79%) underwent initial ERCP while 18 (21%) underwent initial PTBD. Groups did not differ significantly with respect to age, gender, or tumor location. Initial procedure success did not differ between the groups (94% ERCP vs 89% PTBD, p = 0.339). Total number of procedures did not differ significantly between the two groups (ERCP median = 2 vs. PTC median = 2.5, p = 0.83). 21% of patients required ERCP after PTBD compared to 25% of patients requiring PTBD after ERCP (p = 1.00). Procedure success rate (97% ERCP vs. 93% PTBD, p = 0.27) and rates of cholangitis (22% ERCP vs. 17% PTBD, p = 0.58) were similar between the groups. Number of hospitalizations since initial intervention did not differ significantly between the two groups (ERCP median = 1 vs. PTC median = 3.5, p = 0.052).

Conclusions

In patients with CC and biliary obstruction, initial ERCP with stent placement and initial PTBD both represent safe and effective methods of biliary decompression. Initial ERCP and stenting should be considered for relief of biliary obstruction in such patients in centers with advanced endoscopic capabilities.

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References

  1. Saha SK, Zhu AX, Fuchs CS, Brooks GA (2016) Forty-year trends in cholangiocarcinoma incidence in the U.S.: intrahepatic disease on the rise. Oncologist 21(5):594–599

    Article  Google Scholar 

  2. Eckmann KR, Patel DK, Landgraf A et al (2011) Chemotherapy outcomes for the treatment of unresectable intrahepatic and hilar cholangiocarcinoma: a retrospective analysis. Gastrointest Cancer Res 4(5–6):155–160

    PubMed  PubMed Central  Google Scholar 

  3. Ramirez-Merino N, Aix SP, Cortes-Funes H (2013) Chemotherapy for cholangiocarcinoma: an update. World J Gastrointest Oncol 5(7):171–176

    Article  Google Scholar 

  4. Launois B, Reding R, Lebeau G, Buard JL (2000) Surgery for hilar cholangiocarcinoma: French experience in a collective survey of 552 extrahepatic bile duct cancers. J Hepato-biliary-pancreatic Surg 7(2):128–134

    Article  CAS  Google Scholar 

  5. DeOliveira ML, Cunningham SC, Cameron JL et al (2007) Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg 245(5):755–762

    Article  Google Scholar 

  6. Network NCC (2018) Hepatobiliary cancers. NCCN Clinical Practice Guidelines in Oncology, pp 33–40. Accessed 06/09/18

  7. Poruk KE, Pawlik TM, Weiss MJ (2015) Perioperative management of hilar cholangiocarcinoma. J Gastrointest Surg 19(10):1889–1899

    Article  Google Scholar 

  8. Wiggers JK, Groot Koerkamp B, Coelen RJ et al (2015) Percutaneous preoperative biliary drainage for resectable perihilar cholangiocarcinoma: no association with survival and no increase in seeding metastases. Ann Surg Oncol 22:1156–1163

    Article  Google Scholar 

  9. Hirano S, Tanaka E, Tsuchikawa T et al (2014) Oncological benefit of preoperative endoscopic biliary drainage in patients with hilar cholangiocarcinoma. J Hepato-biliary-pancreatic Sci 21(8):533–540

    Article  Google Scholar 

  10. Silva MA, Tekin K, Aytekin F, Bramhall SR, Buckels JA, Mirza DF (2005) Surgery for hilar cholangiocarcinoma; a 10 year experience of a tertiary referral centre in the UK. Eur J Surg Oncol 31(5):533–539

    Article  CAS  Google Scholar 

  11. Zhang XF, Beal EW, Merath K et al (2017) Oncologic effects of preoperative biliary drainage in resectable hilar cholangiocarcinoma: Percutaneous biliary drainage has no adverse effects on survival. J Surg Oncol 117(6):1267–1277

    Article  Google Scholar 

  12. Wiggers JK, Groot Koerkamp B, Coelen RJ et al (2015) Preoperative biliary drainage in perihilar cholangiocarcinoma: identifying patients who require percutaneous drainage after failed endoscopic drainage. Endoscopy 47(12):1124–1131

    Article  Google Scholar 

  13. Masci E, Toti G, Mariani A et al (2001) Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol 96:417

    Article  CAS  Google Scholar 

  14. Szary NM, Al-Kawas FH (2013) Complications of endoscopic retrograde cholangiopancreatography: how to avoid and manage them. Gastroenterol Hepatol 9(8):496–504

    Google Scholar 

  15. Rerknimitr R, Kladcharoen N, Mahachai V, Kullavanijaya P (2004) Result of endoscopic biliary drainage in hilar cholangiocarcinoma. J Clin Gastroenterol 38(6):518–523

    Article  Google Scholar 

  16. Sewnath ME, Karsten TM, Prins MH, Rauws EJA, Obertop H, Gouma DJ (2002) A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice. Ann Surg 236(1):17–27

    Article  Google Scholar 

  17. Moole H, Dharmapuri S, Duvvuri A et al (2016) Endoscopic versus percutaneous biliary drainage in palliation of advanced malignant hilar obstruction: a meta-analysis and systematic review. Can J Gastroenterol Hepatol 2016:4726078

    Article  Google Scholar 

  18. Goenka MK, Goenka U (2014) Palliation: hilar cholangiocarcinoma. World J Hepatol 6(8):559–569

    Article  Google Scholar 

  19. Sangchan A, Kongkasame W, Pugkhem A, Jenwitheesuk K, Mairiang P (2012) Efficacy of metal and plastic stents in unresectable complex hilar cholangiocarcinoma: a randomized controlled trial. Gastrointest Endosc 76(1):93–99

    Article  Google Scholar 

  20. Liberato MJA, Canena JMT (2012) Endoscopic stenting for hilar cholangiocarcinoma: efficacy of unilateral and bilateral placement of plastic and metal stents in a retrospective review of 480 patients. BMC Gastroenterol 12:103

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Louisville, 550 S. Jackson Street, Louisville, KY, 40202, USA

    S. O’Brien, N. Bhutiani, M. E. Egger, A. N. Brown, K. H. Weaver, D. Kline, C. R. Scoggins, R. C. G. Martin II & G. C. Vitale

  2. Department of Radiology, Norton Hospital, Louisville, KY, USA

    L. R. Kelly

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  1. S. O’Brien
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  2. N. Bhutiani
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  3. M. E. Egger
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  4. A. N. Brown
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  5. K. H. Weaver
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  6. D. Kline
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  7. L. R. Kelly
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  8. C. R. Scoggins
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  9. R. C. G. Martin II
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  10. G. C. Vitale
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Correspondence to G. C. Vitale.

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Dr. O’Brien, Dr. Bhutiani, Dr. Egger, Ms. Brown, Ms. Weaver, Mr. Kline, Dr. Kelly, Dr. Scoggins, Dr. Martin, and Dr. Vitale have no conflicts of interest or financial ties to disclose.

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O’Brien, S., Bhutiani, N., Egger, M.E. et al. Comparing the efficacy of initial percutaneous transhepatic biliary drainage and endoscopic retrograde cholangiopancreatography with stenting for relief of biliary obstruction in unresectable cholangiocarcinoma. Surg Endosc 34, 1186–1190 (2020). https://doi.org/10.1007/s00464-019-06871-2

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  • DOI: https://doi.org/10.1007/s00464-019-06871-2

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