Outcomes of endoscopic treatment for malignant biliary obstruction in patients with surgically altered anatomy: analysis of risk factors for clinical failure

Abstract

Background: To evaluate the outcomes of endoscopic retrograde cholangiopancreatography (ERCP) for malignant biliary obstruction (MBO) using short-type double-balloon enteroscope (sDBE) in patients with surgically altered anatomy.Methods: A total of 45 patients with surgically altered anatomy underwent ERCP using sDBE for the treatment of MBO between April 2011 and March 2019. We retrospectively evaluated the clinical and technical success (insertion and biliary intervention success), adverse events, and risk factors for clinical failure.Results: The scope was successfully inserted in the target site in 82.2% of patients (37/45), and among them, biliary intervention success was achieved in 86.4% (32/37).The overall technical success rate was 71.1% (32/45) and clinical success rate was 68.9% (31/45), with an adverse event rate of 11.1%. In multivariate analysis, the presence of peritoneal dissemination (odds ratio, 7.3; 95% confidence interval, 1.5-43.5, p=0.02) was as an independent risk factor for clinical failure. The clinical success rate was 38.5% in patients with peritoneal dissemination and 81.3% in those without peritoneal dissemination.Conclusion: Endoscopic treatment using sDBE in patients without peritoneal dissemination provided favorable outcomes, and it can be an initial treatment for MBO in patients with surgically altered anatomy.

Comparison between Enteroscopy-, Laparoscopy- and Endoscopic Ultrasound-Assisted Endoscopic Retrograde Cholangio-Pancreatography in Patients with Surgically Altered Anatomy: A Systematic Review and Meta-Analysis

“…The initial literature search resulted in 4105 studies, with 76 of them [ 11 , 13 , 15 , 17 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 ,…”

“…Sixteen studies [ 15 , 17 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 ] provided comparisons between two or more modalities. Fifty-five studies evaluated -EA-ERCP, including 53 with BA-ERCP [ 11 , 13 , 15 , 17 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ,…”

“…The pooled rate of technical success for EA-ERCP (55 studies, 2549 procedures) [ 11 , 13 , 15 , 17 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 92 , 93 , 95 , 96 , 97 , 98 , 101 , 102 , 103 ] was 87.3% [95%CI: 85.3–89.4] ( Figure 2 a). When focusing on the individual performance of different EA-ERCP modalities ( Supplementary Figure S1 ), SE-ERCP (4 s...…”

“…When focusing on the individual performance of different EA-ERCP modalities ( Supplementary Figure S1 ), SE-ERCP (4 studies, 170 procedures) [ 42 , 43 , 101 , 102 ] yielded a lower rate of technical success [70.3% (95%CI: 55.1–85.6)]. Moreover, single-balloon enteroscope-assisted ERCP (SBE) [ 15 , 33 , 34 , 35 , 36 , 37 , 38 , 40 , 45 , 48 , 50 , 53 , 54 , 59 , 62 , 63 , 64 , 66 , 68 , 71 , 72 , 92 , 93 , 95 , 101 , 102 , 103 ] (27 studies, 1543 procedures) provided optimal positioning in front of the ampulla and/or anastomosis in 88.1% (95%CI: 85.5–90.6) of cases and double-balloon enteroscope-assisted-ERCP (DBE) in 89.8% (95%CI: 87.1–92.4). Regarding EDGE (9 studies, 253 procedures) [ 77 , 81 , 82 , 86 , 87 , 94 , 97 , 99 , 100 ], the pooled rate of technical success was 97.9% (95%CI: 96.4–99.4); Figure 2 b), while sufficient positioning in front of the ampulla was possible in 99.1% (95%CI: 98.6–99.7); Figure 2 c) of the patients undergoing LA-ERCP (18 studies, 767 procedures) [ 48 , 74 , 75 , 76 ,…”

Triple stent-in-stent placement of novel braided metal stents with a slim delivery system via balloon-assisted enteroscopy

“…The placement of multiple metal stents for hilar malignant biliary obstruction (MBO) is technically challenging, especially for patients with surgically altered anatomy [1]. The laser-cut type of met-al stent has been the only choice [2] until now, with the advent of a novel braided-type metal stent with a 6-Fr delivery system (Niti-S large cell SR slim delivery; 196-cm long; TaeWoong Medical, Gyeonggi-do, Korea) (▶ Fig.…”