A Retrospective Study of Biliary Drainage Strategies for Patients with Malignant Hilar Biliary Strictures

Abstract

Purpose The main aim of this study was to compare the efficacy and safety of different biliary drainage strategies, including percutaneous transhepatic biliary drainage (PTBD) versus endoscopic biliary stenting (EBS) and unilateral versus bilateral stenting, in patients with unresectable malignant hilar biliary strictures (MHBSs). Patients and Methods This was a retrospective review of patients with inoperable MHBSs who underwent biliary drainage by either EBS or PTBD. Efficacy and safety were compared between the two pathways and between unilateral and bilateral stenting in the EBS group. The survival duration was analyzed with K-M curves and Log rank tests. Results From January 2015 to December 2019, a total of 206 (126: EBS and 80: PTBD) patients with MHBSs were enrolled in our study and underwent 270 procedures (173: EBS and 97: PTBD). Bilateral stenting was superior to unilateral stenting in terms of clinical success (69.6% vs 50.6%, p=0.039), especially for patients with Bismuth type IV (70.0% vs 30.3%, p=0.002). A higher decrease in bilirubin was seen with PTBD in patients with Bismuth types III–IV (66.9 vs 36.7, p=0.006). A survival advantage was seen in successful drainage (227 days vs 82 days, p<0.001), lower tumor-node-metastasis (TNM) scores (I–II) (195 days vs 139 days, p=0.012), and cholangiocarcinoma (184 days vs 84 days, p=0.001). Conclusion For patients with advanced MHBSs, bilateral stenting may achieve a better drainage effect than unilateral stenting, and PTBD may have a better performance in relieving cholestasis than EBS. Successful drainage and cholangiocarcinoma may provide greater long-term survival benefits.

Biliary Drainage in Palliative and Curative Intent European Patients with Hilar Cholangiocarcinoma and malignant hilar obstruction: a retrospective single center analysis

“…However, the patients evaluated were younger and a broad range of tumor entities causing MHO such as hepatocellular carcinoma, gallbladder cancer and metastases of distant primary tumors were included. Similarly, Liang et al reported CS rates (in this case TSB decrease > 75%) of 50.6% for unilateral and 69.6% for bilateral drainage (EBD or PTBD) in Chinese palliative patients with MHO compared to 29.2% in our cohort [14]. Again, patients were younger and tumor entities other than CCA were included.…”

Stent insertion for malignant hilar obstruction: a meta-analysis of percutaneous versus endoscopic approaches

“…Technical success was defined as the successful deployment of the inserted stent across the site of the obstruction [15]. Clinical success was defined as a reduction in total bilirubin level to < 75% of the baseline level prior to treatment within a 1-month follow-up period [14]. Major complications associated with stenting included haemorrhage, cholangitis, and pancreatitis.…”

“…The initial literature search retrieved 650 articles, of which 11 were ultimately included in the final meta-analysis (Figure 1), including one RCT [11] and 10 retrospective studies [12][13][14][15][16][17][18][19][20][21]. Figure 2 depicts the risk of bias results for this RCT, while all 10 retrospective studies exhibited NOS scores ranging from 6 to 8.…”

“…Prior meta-analyses have suggested that bilateral stenting can achieve superior clinical success rates to those associated with unilateral stenting when treating MHO patients, while also lowering rates of stent dysfunction [9,10]. Different stent insertion strategies in MHO patients can additionally determine the clinical efficacy of stent insertion [11][12][13][14][15][16][17][18][19][20][21]. Endoscopic and percutaneous approaches are the most common strategies employed for biliary stent insertion [11][12][13][14][15][16][17][18][19][20][21].…”

“…Different stent insertion strategies in MHO patients can additionally determine the clinical efficacy of stent insertion [11][12][13][14][15][16][17][18][19][20][21]. Endoscopic and percutaneous approaches are the most common strategies employed for biliary stent insertion [11][12][13][14][15][16][17][18][19][20][21]. Some prior meta-analyses have examined the relative clinical efficacy of percutaneous and endoscopic biliary drainage strategies in MHO patients [22][23][24].…”