Palliative treatment with self-expandable metallic stents in patients with advanced type III or IV hilar cholangiocarcinoma: a percutaneous versus endoscopic approach

Paik, Woo Hyun; Park, Young Soo; Hwang, Jin Hyeok; Lee, Sang Hyub; Yoon, Chang Jin; Kang, Sung Gwon; Lee, Jae Kwan; Ryu, Ji Kon; Kim, Yong Tae; Yoon, Yong Bum

doi:10.1016/j.gie.2008.04.005

Cited by 249 publications

(232 citation statements)

References 33 publications

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“…However, the complexity of the hilar structures and the frequent involvement of the confluence of the hepatic ducts results in certain patients being unable to achieve successful internal drainage through the endoscopic approach (6). Percutaneous biliary stenting is technically simple compared with endoscopic biliary stenting, particularly for palliation using Bismuth type III and IV strictures (5).…”

Section: B Amentioning

confidence: 99%

“…Percutaneous biliary stenting is technically simple compared with endoscopic biliary stenting, particularly for palliation using Bismuth type III and IV strictures (5). Paik et al indicated that percutaneous biliary stenting may be used as a first treatment modality for biliary decompression in patients with advanced type III or IV hilar cholangiocarcinoma, as the success rate of biliary drainage in the percutaneous biliary stenting group was increased compared with that of the endoscopic biliary stenting group (92.7 vs. 77.3%; P= 0.049) (6). This study also revealed that successful drainage prolongs the survival time of patients compared with the survival time of patients with failed biliary drainage (8.7 vs. 1.8 months; P<0.001) (6).…”

Section: B Amentioning

confidence: 99%

“…In the previous two decades, percutaneous biliary stenting and radiotherapy (RT) were palliative care programs that were widely used for patients with unresectable hilar cholangiocarcinoma (4)(5)(6)(7)(8)(9). However, the risk of complications of percutaneous biliary stenting was increased compared with the risks of endoscopic biliary stenting (10).…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous biliary stenting combined with radiotherapy as a treatment for unresectable hilar cholangiocarcinoma

et al. 2015

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Abstract. Hilar cholangiocarcinoma is often unresectable at the time of the initial diagnosis, and the provision of a definite palliative benefit is important in patients with unresectable hilar cholangiocarcinoma. The aim of the present study was to evaluate the safety of percutaneous biliary stenting and to analyze whether percutaneous biliary stenting combined with radiotherapy (RT) prolonged the stent patency and survival time of patients. In total, the cases of 38 patients with unresectable hilar cholangiocarcinoma that underwent percutaneous biliary stenting at the Navy General Hospital were retrospectively reviewed in the present study. Uncovered metallic stenting (UMS) combined with RT was administered to 25 patients, and UMS alone was administered to 13 patients. The records of early complications subsequent to percutaneous biliary stenting were collected, and the stent patency and survival times of patients were analyzed and compared between the two groups. The technical success rate of the procedure was 100% and the successful drainage rate was 86.8%. The overall early complication rate was 15.8% and the procedure-associated mortality rate was 2.6%. The median stent patency was 326 days in the UMS+RT group and 196 days in the UMS group (P= 0.022). The UMS+RT group (median, 367 days) demonstrated a longer survival time compared with the UMS group (median, 267 days; P= 0.025). Percutaneous biliary stenting offers a safe and effective method for the palliative treatment of patients with unresectable hilar cholangiocarcinoma, and percutaneous biliary stenting combined with RT may prolong stent patency and patient survival time.

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Section: B Amentioning

confidence: 99%

Section: B Amentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Percutaneous biliary stenting combined with radiotherapy as a treatment for unresectable hilar cholangiocarcinoma

et al. 2015

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“…In biliary obstruction in the hepatic hilum, effective drainage is difficult to achieve because of the anatomical complexity of the bile ducts. Various procedures of biliary drainage of hilar biliary obstruction have been performed: percutaneous or endoscopic routes [1][2][3][4][5] , plastic or metallic stents [6][7][8][9][10][11] , and unilateral or bilateral hepatic duct drainage [11][12][13][14][15][16][17][18][19][20][21] . However, no consensus has been reached on the optimal drainage strategy for treating biliary obstruction.…”

Section: Introductionmentioning

confidence: 99%

Biliary drainage strategy of unresectable malignant hilar strictures by computed tomography volumetry

Takahashi

Fukasawa

Satô

et al. 2015

WJG

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AIM:To identify criteria for predicting successful drainage of unresectable malignant hilar biliary strictures (UMHBS) because no ideal strategy currently exists. METHODS:We examined 78 patients with UMHBS who underwent biliary drainage. Drainage was considered effective when the serum bilirubin level decreased by ≥ 50% from the value before stent placement within 2 wk after drainage, without additional intervention. Complications that occurred within 7 d after stent placement were considered as early complications. Before drainage, the liver volume of each section (lateral and medial sections of the left liver and anterior and posterior sections of the right liver) was measured using computed tomography (CT) volumetry. Drained liver volume was calculated based on the volume of each liver section and the type of bile duct stricture (according to the Bismuth classification). Tumor volume, which was calculated by using CT volumetry, was excluded from the volume of each section. Receiver operating characteristic (ROC) analysis was performed to identify the optimal cutoff values for drained liver volume. In addition, factors associated with the effectiveness of drainage and early complications were evaluated. cirrhosis) and 50% for patients with impaired liver function (with decompensated liver cirrhosis). The sensitivity and specificity of these cutoff values were 82% and 80% for preserved liver function, and 100% and 67% for impaired liver function, respectively. Among patients who met these criteria, the rate of effective drainage among those with preserved liver function and impaired liver function was 90% and 80%, respectively. The rates of effective drainage in both groups were significantly higher than in those who did not fulfill these criteria (P < 0.001 and P = 0.02, respectively). Drainage-associated cholangitis occurred in 9 patients (12%). A smaller drained liver volume was associated with drainage-associated cholangitis (P < 0.01). RESULTS: CONCLUSION:Liver volume drainage ≥ 33% in patients with preserved liver function and ≥ 50% in patients with impaired liver function correlates with effective biliary drainage in UMHBS. Core tip: An ideal biliary drainage strategy for unresectable malignant hilar biliary strictures (UMHBS) has not been defined. The aim of our study was to identify useful criteria for predicting successful drainage of UMHBS. In the present study, multivariate analysis revealed that liver function and drained liver volume calculated by computed tomography volumetry (CTV) are independent factors of drainage effectiveness for UMHBS. Receiver operating characteristic analysis showed cutoff values of 33% of liver volume for patients with preserved liver function and 50% for patients with impaired liver function. Before attempting biliary drainage procedures, establishing an appropriate drainage strategy using CTV is important.Takahashi E, Fukasawa M, Sato T, Takano S, Kadokura M, Shindo H, Yokota Y, Enomoto N. Biliary drainage strategy of unresectable malignant hilar strictures by...

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“…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].…”

Section: Drainage Techniquesmentioning

confidence: 99%

Role of Preoperative Biliary Drainage in Resectable Hilar Cholangiocarcinoma

Caruso¹

2016

J surg

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Palliative treatment with self-expandable metallic stents in patients with advanced type III or IV hilar cholangiocarcinoma: a percutaneous versus endoscopic approach

Cited by 249 publications

References 33 publications

Percutaneous biliary stenting combined with radiotherapy as a treatment for unresectable hilar cholangiocarcinoma

Percutaneous biliary stenting combined with radiotherapy as a treatment for unresectable hilar cholangiocarcinoma

Biliary drainage strategy of unresectable malignant hilar strictures by computed tomography volumetry

Role of Preoperative Biliary Drainage in Resectable Hilar Cholangiocarcinoma

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