Endoscopic and Percutaneous Preoperative Biliary Drainage in Patients with Suspected Hilar Cholangiocarcinoma

Abstract

Introduction Controversy exists over the preferred technique of preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCCA) requiring major liver resection. The current study compared outcomes of endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) in patients with resectable HCCA. Methods One hundred fifteen consecutive patients were explored for HCCA between 2001 and July 2008 and assigned by initial PBD procedure to either EBD or PTBD. Results Of these patients, 101 (88%) underwent PBD; 90 patients underwent EBD as primary procedure, and 11 PTBD. The technical success rate of initial drainage was 81% in the EBD versus 100% in the PTBD group (P=0.20). Stent dislocation was similar in the EBD and PTBD groups (23% vs. 20%, P=0.70). Infectious complications were significantly more common in the endoscopic group (48% vs. 9%, P<0.05). Patients in the EBD group underwent more drainage procedures (2.8 vs. 1.4, P<0.01) and had a significantly longer drainage period until laparotomy (mean 15 weeks vs. 11 weeks in the PTBD group; P<0.05). In 30 patients, EBD was converted to PTBD due to failure of the endoscopic approach. Conclusions Preoperative percutaneous drainage could outperform endoscopic stent placement in patients with resectable HCCA, showing fewer infectious complications, using less procedures.

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2nd English edition

“…Cholecystitis due to the obstruction of cystic duct or pancreatitis due to the obstruction of main pancreatic duct are also potential causes of fever. In such cases, CT examination is useful for the diagnosis [76,78,82,83].…”

Role of Preoperative Biliary Drainage in Resectable Hilar Cholangiocarcinoma

“…EBD in patients affected by tumors of proximal bile duct is often a difficult maneuver, affected by a high failure rate, which may require the association of more than one drainage techniques (usually PTBD). Moreover, after the procedure, evaluation of tumor length and extension may be less accurate in the presence of one or more stents and for local inflammation and fibrosis [8,9]. EBD is affected by an higher rate of postprocedural complications compared to other techniques, with an overall 25-50% morbidity and 3-5% mortality rate [9,10].…”

“…This technique consists of selectively cannulating the bile duct by a percutaneous approach, usually under ultrasound guide, and placement of one or more biliary stents in the biliary system. It has been reported that the post-procedural morbidity rate of percutaneous techniques is lower compared to the endoscopic technique [9]. PTBD is a direct approach for bile duct decompression in patient with HC and it is usually the procedure of choice in most groups due to effectiveness in decreasing serum bilirubin with low rates of cholangitis [9,10].…”

“…It has been reported that the post-procedural morbidity rate of percutaneous techniques is lower compared to the endoscopic technique [9]. PTBD is a direct approach for bile duct decompression in patient with HC and it is usually the procedure of choice in most groups due to effectiveness in decreasing serum bilirubin with low rates of cholangitis [9,10]. In particular, success rate of bile duct decompression is significantly higher by percutaneous approach than EBD in locally advanced HC [11].…”

Selection of decompression bile ducts in the treatment of patients with obstructive jaundice of tumor genesis

“…В отечественной литературе имеется небольшое количест-во публикаций, посвященных проблеме эндоскопического стентирования, что, ве-роятно, связано с ещѐ недостаточно ши-роким применением данного способа де-компрессии в отечественных хирургиче-ских клиниках. Зарубежные авторы, в свою очередь, отмечают высокую эффек-тивность данного способа декомпрессии, а также малое количество послеопераци-онных осложнений [10].…”