Are endoscopic or percutaneous biliary drainage effective forobstructive jaundice caused by hepatocellular carcinoma?

Cho, Hyun Chin; Lee, Jong Kyun; Lee, Kwang Hyuck; Lee, Kyu Taek; Paik, Seung Woon; Choo, Sung Wook; Soo, Young; Choo, In Wook

doi:10.1097/meg.0b013e3283436ff6

Cited by 25 publications

(21 citation statements)

References 20 publications

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“…However, the latter studies mainly focused on biliary tract cancers such as cholangiocellular carcinoma and periampullary cancer, which differ from HCC in terms of tumor characteristics, vulnerability to infection and poor hepatic functions. Indeed, other studies on patients with HCC report much higher EBD complication rates (34-37%) than the present study [10,23]. …”

Section: Discussioncontrasting

confidence: 49%

Clinical Usefulness of Endoscopic Palliation in Patients with Biliary Obstruction Caused by Hepatocellular Carcinoma

Choi¹,

Shim²,

Park³

et al. 2013

Digestion

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Background/Aims: To evaluate the clinical usefulness of endoscopic biliary drainage (EBD) in patients with hepatocellular carcinoma (HCC). Methods: A total of 111 jaundiced patients underwent attempted EBD for relief of HCC-related biliary stricture at our hospital over a 5-year period and all were included in the intention-to-treat (ITT) analysis. Results: After an endoscopic attempt at drainage, 46 (41.4%) of the 111 patients achieved a favorable response. Biliary cannulation failed in 5 patients. Child-Pugh class C, portal vein thrombosis and severe hyperbilirubinemia were negatively correlated with a favorable EBD response. In the ITT population, 40 (87.0%) of the favorable responders received further treatment for HCC, >2 (3.1%) of the unfavorable responders (p < 0.001). The median survival time for ITT patients with and without a favorable response to EBD was 8.7 and 1.3 months, respectively (p < 0.001). Cox's model showed that a favorable EBD response was an independent predictor of longer survival (hazard ratio 0.20, p < 0.001). Conclusions: For HCC patients with tumor-related biliary obstruction, predictors of effective endoscopic palliation of cholestasis were relatively mild hyperbilirubinemia and preserved liver function and intact portal vein flow. A favorable EBD response was associated with longer survival outcomes.

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Section: Discussioncontrasting

confidence: 49%

Clinical Usefulness of Endoscopic Palliation in Patients with Biliary Obstruction Caused by Hepatocellular Carcinoma

Choi¹,

Shim²,

Park³

et al. 2013

Digestion

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“…The primary outcomes were short-term clinical outcomes, including the rate of successful drainage and procedure-related adverse events, such as post-ERCP pancreatitis, cholangitis, hemorrhage, biloma, or liver abscess. Successful biliary drainage was defined as the placement of the stent across the stricture with appropriate radiographic positioning, immediate biliary decompression, and at least a 30 % reduction of serum bilirubin level within 2 -4 weeks [8,18]. Drainage failure was considered when serum bilirubin level was not reduced by 30 % within 2 -4 weeks, or when clinical signs and symptoms of cholangitis persisted after the procedure.…”

Section: Definition Of Events and Study Outcome Measurementsmentioning

confidence: 99%

“…Despite the fact that obstructive jaundice is infrequent in patients with HCC, distinguishing obstructive jaundice from jaundice due to liver parenchymal insufficiency is clinically important, in that biliary drainage may be beneficial in the former case [7,8]. Effective biliary decompression can improve the quality of life by reducing the associated pruritus, malaise, and cholangitis, and liver function and survival can also be improved [8,9]. Endoscopic retrograde biliary drainage (ERBD) rather than percutaneous transhepatic biliary drainage (PTBD) is accepted as the standard procedure for the palliation of obstructive jaundice in patients with HCC because of its low hemorrhagic risk and longer duration of patency [10,11].…”

mentioning

confidence: 99%

“…However, jaundice related to malignant biliary obstruction is less common than that related to diffuse tumor infiltration of liver parenchyma or progressive terminal liver failure in HCC patients [5,6]. Despite the fact that obstructive jaundice is infrequent in patients with HCC, distinguishing obstructive jaundice from jaundice due to liver parenchymal insufficiency is clinically important, in that biliary drainage may be beneficial in the former case [7,8]. Effective biliary decompression can improve the quality of life by reducing the associated pruritus, malaise, and cholangitis, and liver function and survival can also be improved [8,9].…”

mentioning

confidence: 99%

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Self-expandable metallic stents vs. plastic stents for endoscopic biliary drainage in hepatocellular carcinoma

et al. 2015

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“…The independent risk factors for ineffective biliary drainage were total bilirubin >13 mg/dl and Child-Turcotte-Pugh class C, and the mean survival times of patients who received effective or ineffective biliary drainage were 247 and 44 days, respectively [35]. When effective biliary drainage was achieved after an appropriate biliary drainage procedure in patients with obstructive jaundice caused by HCC, survival improved.…”

Section: Drainagementioning

confidence: 99%

Hepatocellular Carcinoma with Obstructive Jaundice: Endoscopic and Percutaneous Biliary Drainage

Minami

Kudo²

2012

Dig Dis

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Among patients with later stage hepatocellular carcinoma (HCC), only 1–12% manifest obstructive jaundice as the initial complaint. Endoscopic retrograde biliary drainage (ERBD) and percutaneous transhepatic biliary drainage (PTBD) are the two main non-surgical treatment options for obstructive jaundice in patients with HCC. ERBD is usually the first-line treatment because of its low hemorrhage risk. Some have reported that the successful drainage rate ranges from 72 to 100%. Mean stent patency time and mean survival range from 1.0 to 15.9 and 2.8 to 12.3 months, respectively. PTBD is often an important second-line treatment when ERBD is impossible. With regard to materials, metallic stents offer the benefit of longer patency than plastic stents. The dominant effect of biliary drainage suggests that successful jaundice therapy could enhance anti-cancer treatment by increasing life expectancy, decreasing mortality, or both. We present an overview of the efficacy of endoscopic and percutaneous drainage for obstructive jaundice in patients with HCC who are not candidates for surgical resection and summarize the current indications and outcomes of reported clinical use.

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Are endoscopic or percutaneous biliary drainage effective forobstructive jaundice caused by hepatocellular carcinoma?

Abstract: When effective biliary drainage was achieved after an appropriate biliary drainage procedure in patients with obstructive jaundice caused by HCC, survival improved.

Cited by 25 publications

References 20 publications

Clinical Usefulness of Endoscopic Palliation in Patients with Biliary Obstruction Caused by Hepatocellular Carcinoma

Clinical Usefulness of Endoscopic Palliation in Patients with Biliary Obstruction Caused by Hepatocellular Carcinoma

Self-expandable metallic stents vs. plastic stents for endoscopic biliary drainage in hepatocellular carcinoma

Hepatocellular Carcinoma with Obstructive Jaundice: Endoscopic and Percutaneous Biliary Drainage

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