An Unsuccessful Randomized Trial of Percutaneous vs Endoscopic Drainage of Suspected Malignant Hilar Obstruction

Elmunzer, B. Joseph; Smith, Zachary L.; Tarnasky, Paul R.; Wang, Andrew Y.; Yachimski, Patrick; Banovac, Filip; Buscaglia, Jonathan M.; Buxbaum, James; Chak, Amitabh; Chong, Bradford; Coté, Gregory A.; Draganov, Peter V.; Dua, Kulwinder S.; Durkalski, Valerie; Geller, Brian; Jamil, Laith H.; Keswani, Rajesh N.; Khashab, Mouen A.; Law, Ryan; Lo, Simon K.; McCarthy, Seán; Selby, J. Bayne; Singh, Vikesh K.; Taylor, Jason R.; Willingham, Field F.; Spitzer, Rebecca L.; Foster, Lydia D

doi:10.1016/j.cgh.2020.05.035

Cited by 13 publications

(11 citation statements)

References 7 publications

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“…A randomized trial (the INTERCPT trial) comparing EBD and PTBD for initial biliary drainage in patients with cholestasis and suspicion of malignant hilar obstruction was discontinued early because of lack of accrual. 19 In 2 years, only 13 patients were included. Less than half of all patients achieved the primary endpoint of 50% bilirubin level decrease in 3 weeks.…”

Section: Discussionmentioning

confidence: 99%

Success, complication, and mortality rates of initial biliary drainage in patients with unresectable perihilar cholangiocarcinoma

Keulen

Gaspersz²,

Vugt³

et al. 2022

Surgery

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Section: Discussionmentioning

confidence: 99%

Success, complication, and mortality rates of initial biliary drainage in patients with unresectable perihilar cholangiocarcinoma

Keulen

Gaspersz²,

Vugt³

et al. 2022

Surgery

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“…A recent RCT was terminated prematurely because of the slow process of admission. 27 We included a large number of patients with MHBSs to compare PTBD with EBD, as well as bilateral with unilateral stenting in aspect of short-term and long-term outcomes. Though, further properly powered RCTs addressing this topic are warranted to provide more efficient approaches for palliation.…”

Section: Discussionmentioning

confidence: 99%

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

Liang¹,

Li²,

Liu³

et al. 2021

CMAR

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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.

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“…The results of an unsuccessful RCT were recently published. Lack of funding, provider/institutional bias in favor of one procedure, and logistical challenges were cited as possible responsible factors of failure[ 74 ]. Therefore, until high-quality observational data or RCTs become available, one must rely on personal judgment, according to expertise and specific conditions.…”

Section: Endoscopic Vs Percutaneous Biliary Drainage — Pro and Consmentioning

confidence: 99%

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

Mocan¹,

Horhat²,

Moiş³

et al. 2021

WJGO

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Hilar cholangiocarcinoma (hCCA) is a primary liver tumor associated with a dim prognosis. The role of preoperative and palliative biliary drainage has long been debated. The most common techniques are endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD); however, recently developed endoscopic ultrasound-assisted methods are gaining more atention. Selecting the best available method in any specific scenario is crucial, yet sometimes challenging. Thus, this review aimed to discuss the available techniques, indications, perks, pitfalls, and timing-related issues in the management of hCCA. In a preoperative setting, PTBD appears to have some advantages: low risk of postprocedural complications (namely cholangitis) and better priming for surgery. For palliative purposes, we propose ERCP/PTBD depending on the experience of the operators, but also on other factors: the level of bilirubin (if very high, rather PTBD), length of the stenosis and the presence of cholangitis (PTBD), ERCP failure, or altered biliary anatomy.

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An Unsuccessful Randomized Trial of Percutaneous vs Endoscopic Drainage of Suspected Malignant Hilar Obstruction

Cited by 13 publications

References 7 publications

Success, complication, and mortality rates of initial biliary drainage in patients with unresectable perihilar cholangiocarcinoma

Success, complication, and mortality rates of initial biliary drainage in patients with unresectable perihilar cholangiocarcinoma

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

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

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