Compliance with evidence‐based multidisciplinary guidelines on perihilar cholangiocarcinoma

Abstract

Background: Discrepancies are often noted between management of perihilar cholangiocarcinoma (PHC) in regional hospitals and the eventual treatment plan in specialized centers. Objective: The objective of this article is to evaluate whether regional centers adhere to guideline recommendations following implementation in 2013. Methods: Data were analyzed from all consecutive patients with suspected PHC referred to our academic center between June 2013 and December 2015. Frequency and quality of biliary drainage and imaging at referring centers were assessed as well as the impact of inadequate initial drainage. Results: Biliary drainage was attempted at regional centers in 83 of 158 patients (52.5%), with a technical and therapeutic success rate of 79.5% and 50%, respectively, and a complication rate of 45.8%. The computed tomography protocol was not in accordance with guidelines in 52.8% of referrals. In 45 patients (54.2%) who underwent drainage in regional centers, additional drainage procedures were required after referral. Initial inadequate biliary drainage at a regional center was significantly associated with more procedures and a prolonged waiting time until surgery. A trend toward more drainagerelated complications was observed among patients with inadequate initial drainage (54.7% vs. 39.0%, p ¼ 0.061). Conclusion: Despite available guidelines, suboptimal management of PHC persists in many regional centers and affects eventual treatment strategies.

Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated October 2017

“…As endoscopic stenting in malignant hilar strictures (MHSs) is an advanced procedure with a relatively high risk of failure, and survival is severely hampered after failed drainage [156,157], the endos-copistʼs experience is even more important for MHSs than for distal malignant biliary strictures, as is the prompt availability of PTBD. Nevertheless, many patients with MHS are admitted to referral centers with a biliary stent already in place [158].…”

Nationwide treatment and outcomes of perihilar cholangiocarcinoma

“…The more than twofold higher resection rate in patients diagnosed in academic centres compared to non‐academic centres suggests that some patients were eligible but not considered and not referred for surgery. A previous study in an tertiary referral center already observed that the assessment of resectability at the referring center was not always accurate 15 . The study found that one‐third of patients referred with initially presumed unresectable disease were considered resectable at the tertiary center.…”

“…A previous study in an tertiary referral center already observed that the assessment of resectability at the referring center was not always accurate. 15 The study found that one‐third of patients referred with initially presumed unresectable disease were considered resectable at the tertiary center. However, since the study only included referred patients the problem was likely underestimated, which is demonstrated by the difference in resection rate in the present nationwide study.…”

United European Gastroenterology Journal at a turning point

“…The United European Gastroenterology Journal is keen on serving its readers with material that has the potential to improve their clinical practice 2 . There are a number of areas with considerably large clinical practice variation that could benefit from better standardization 3–5 . With continuously increasing information density, many appreciate seeing decisive papers such as clinical guidelines in the United European Gastroenterology Journal .…”

“…2 There are a number of areas with considerably large clinical practice variation that could benefit from better standardization. 3–5 With continuously increasing information density, many appreciate seeing decisive papers such as clinical guidelines in the United European Gastroenterology Journal . Rightly so, guidelines and position papers continue to enjoy huge popularity with our readership.…”