Percutaneous transhepatic biliary drainage may be the preferred preoperative drainage method in hilar cholangiocarcinoma

Abstract

Background and study aims Preoperative biliary drainage of hilar cholangiocarcinoma (HC) is controversial. The goal of this study was to compare the clinical outcome and associated complications for types II, III, and IV HC managed by percutaneous transhepatic biliary drainage (PTBD) and endoscopic retrograde cholangiopancreatography (ERCP). Patients and methods Between January 2011 and June 2017, a total of 180 patients with II, III, and IV HC were enrolled in this retrospective cohort study. According to the drainage method, patients were divided into two groups: PTBD (n = 81) and ERCP (n = 99). This study was registered with ClinicalTrials.gov, NCT03104582, and was completed. Results Compared with the PTBD group, the ERCP group had a higher incidence of post-procedural cholangitis (37 [37.37 %] vs. 18 [22.22 %], P = 0.028) and pancreatitis (17 [17.17 %] vs. 2 [2.47 %], P = 0.001); required more salvaged biliary drainage (18 [18.18 %] vs. 5 [6.17 %], P = 0.029), and incurred a higher cost (P < 0.05). Patients with type III and IV HC in the ERCP group had more cholangitis than those in the PTBD group (26 [36.62 %] vs. 11 [18.03 %], P = 0.018). The rate of cholangitis in patients who received endoscopic bilateral biliary stents insertion was higher than patients with unilateral stenting (23 [50.00 %] vs. 9 [26.47 %], P = 0.034), and underwent PTBD internal-external drainage had a higher incidence of cholangitis than those with only external drainage (11 [34.36 %] vs. 7 [14.29 %], P = 0.034). No significant difference in the rate of cholangitis was observed between the endoscopic unilateral stenting group and the endoscopic nasobiliary drainage group (9 [26.47 %] vs. 5 [26.32 %], P = 0.990). Conclusion Compared to ERCP, PTBD reduced the rate of cholangitis, pancreatitis, salvage biliary drainage, and decreased hospitalization costs in patients with types II, III, and IV HC. Risk of cholangitis for patients with types III and IV was significantly lower in the PTBD group.

Endoscopic or percutaneous biliary drainage in hilar cholangiocarcinoma: When and how?

“…In terms of procedure-related complications ( e.g. , cholangitis and pancreatitis) two other studies found PTBD to be superior to ERCP[ 63 , 64 ]. Another critical aspect is the cost associated with each method.…”

Should patients with unresectable gallbladder cancer with hilar involvement undergo unilateral or bilateral percutaneous biliary drainage in the setting of cholangitis?

“…Most of the studies report the incidence of post-intervention cholangitis in the setting of malignant biliary obstruction. In the study by Saluja et al, 43% of the GBC patients had cholangitis at baseline evaluation, requiring biliary drainage [5]. The grade of cholangitis was not reported.…”

“…Biliary drainage represents an important palliation strategy for these patients [4]. In general, endoscopic drainage is the preferred choice for malignant lower end biliary obstruction [5]. In patients with GBC with perihilar involvement, percutaneous transhepatic biliary drainage (PTBD) is better than endoscopic drainage [6].…”

Cholangiocarcinoma as an Indication for Liver Transplantation in the Era of Transplant Oncology

“…The authors described a cut-off value of 2.5 mg/dL and 6.2 mg/dL for morbidity and mortality, respectively [32]. In the case of major hepatic resection, biliary drainage of the FLR should be strongly recommended [33,34]. There are two biliary drainage procedures: percutaneous transhepatic biliary drainage (PTBD) and endoscopic biliary drainage (EBD).…”