Step-wise endoscopic approach to palliative bilateral biliary drainage for unresectable advanced malignant hilar obstruction

The ideal type of stent utilized at index endoscopic retrograde cholangiopancreatography (ERCP) in management of malignant hilar obstruction (MHO) remains unclear. We aimed to determine the ideal stent choice in patients with MHO. In this retrospective study, patients with unresectable MHO were sepa...

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Published in:Scientific reports 2019-09, Vol.9 (1), p.13207-9, Article 13207
Main Authors: Choi, Jin Ho, Lee, Sang Hyub, You, Min Su, Shin, Bang-Sup, Choi, Young Hoon, Kang, Jinwoo, Jang, Sunguk, Paik, Woo Hyun, Ryu, Ji Kon, Kim, Yong-Tae
Format: Article
Language:English
Subjects:
Aged
Bile Duct Neoplasms - mortality
Bile Duct Neoplasms - surgery
Bile Duct Neoplasms - therapy
Bile Ducts, Intrahepatic - surgery
Cholangiopancreatography, Endoscopic Retrograde - instrumentation
Cholangiopancreatography, Endoscopic Retrograde - methods
Drainage
Endoscopy
Female
Gallbladder Neoplasms - mortality
Gallbladder Neoplasms - surgery
Gallbladder Neoplasms - therapy
Humans
Implants
Kaplan-Meier Estimate
Klatskin Tumor - surgery
Klatskin Tumor - therapy
Male
Middle Aged
Palliation
Plastics
Retrospective Studies
Self Expandable Metallic Stents
Stents
Survival
Treatment Outcome
Wound drainage
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Summary:The ideal type of stent utilized at index endoscopic retrograde cholangiopancreatography (ERCP) in management of malignant hilar obstruction (MHO) remains unclear. We aimed to determine the ideal stent choice in patients with MHO. In this retrospective study, patients with unresectable MHO were separated into the plastic stent (PS) group and the self-expandable metal stent (SEMS) group. The primary outcome was the risk and rate of rescue percutaneous transhepatic biliary drainage (PTBD). The secondary outcomes were the progression-free survival, the overall survival and the PTBD-free period (days). Thirty-six patients in the PS group and 38 patients in the SEMS group were enrolled. The risk for PTBD was higher in SEMS group (HR = 2.205, 95% C.I. 0.977-4.977, P = 0.057). The rate of PTBD was significantly lower in the PS group. (22.2% vs 50.0%, P = 0.017) There were no differences in overall survival and progression-free survival (410 and 269 in the PS group, 395 and 266 in the SEMS group, P = 0.663 and P = 0.757). The PTBD-free period was significantly longer in the PS group. (836.43 vs 586.40, P = 0.039) Although comparable in clinical efficacy, utilization of PS at index ERCP may reduce patient's discomfort by avoiding PTBD and prolonging PTBD-free period in patients with MHO.
ISSN:2045-2322
2045-2322
DOI:10.1038/s41598-019-48384-x