Comparison of The Initial Endoscopic Versus Percutaneous Approach Biliary Drainage for Palliative Perihilar Cholangiocarcinoma

Abstract

1.1 Background: Percutaneous Transhepatic Biliary Drainage (PTBD) and endoscopic retrograde biliary drainage (ERBD) had been widely used for unresectable perihilar cholangiocarcinoma (PHC). The optimal type of biliary drainage is still a matter of debate. We aim to compare the efficacy and complications of PTBD and ERBD in the unresectable PHC. Patients and Methods:From January 2013 to December 2020, 1145 patients were diagnosed with cholangiocarcinoma or gall bladder cancer in a tertiary hospital cancer registry. We excluded those with resectable tumor, combination intrahepatic tumor or without any treatment. Twenty-seven patients received initial ERBD (n = 18) or PTBD (n = 9) for palliative treatment of unresectable PHC. Results:Age, gender, tumor stage, or Bismuth type were similar between the two groups. The clinical successful rates of drainage were similar between the PTBD and the ERBD groups (66.7% vs. 50.0%, p = 0.683). Two groups had similar complication rates. The PTBD group had a longer survival time in trend (p = 0.184) than ERBD group in the 1-year follow-up. There was a higher dislocation rate in the PTBD (55.5%) than the ERBD (14.3%) group in trend (p = 0.066), as the consequence of shorter patency time in the PTBD than ERBD group (47.0 ± 32.8 days vs. 156 ± 151.1 days, p = 0.083) 1.4. Conclusions: ERBD and PTBD were used as therapeutic op-tions to improve obstructive jaundice in palliative PHC patients with similar complications and could be each other's rescue method if initial drainage approach had no clinical response.