Long-Term Results of Percutaneous Transhepatic Cholangiographic Drainage for Palliation of Malignant Biliary Obstruction

Sut, Michał; Kennedy, Raymond; McNamee, John; Collins, Anton; Clements, Barry

doi:10.1089/jpm.2010.0205

Cited by 25 publications

(15 citation statements)

References 7 publications

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“…The median LOS was also significantly higher in the PBS group compared to the EBS group (25 days vs. 19 days, respectively; p < 0.001). The median LOS of 25 days obtained for the PBS group in this study was consistent with the median LOS reported by Sut et al [23] in a long-term [20] in a randomized trial of endoscopic stenting treatment for malignant lower bile duct obstruction. In another randomized clinical trial, Pinol et al [15] demonstrated that, in terms of the treatment actually administered, the cost of percutaneous stent placement is significantly higher than the cost of endoscopic prosthesis placement with respect to either the initial admission or the overall treatment.…”

Section: Discussionsupporting

confidence: 91%

Biliary stenting for unresectable cholangiocarcinoma: A population‐based study of long‐term outcomes and hospital costs in Taiwan

Yang

Shi

Huang

et al. 2015

The Kaohsiung J of Med Scie

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Few studies have compared percutaneous biliary stenting (PBS) and endoscopic biliary stenting (EBS) in terms of long-term effects on cholangiocarcinoma (CC), and few have systematically evaluated outcome associations in Taiwan. This study aimed to compare long-term outcomes between two treatments for unresectable CC: PBS and EBS. After propensity score matching (PSM) to reduce the effect of selection bias, 1002 CC patients were included in this analysis: 501 in the PBS group and 501 in the EBS group. The Kaplan-Meier method was used to construct the survival curve for all CC patients, and the Cox proportional hazards model was used for multivariate assessment of outcome predictors. After PSM, group comparisons revealed a significantly longer length of stay in the PBS group compared to the EBS group (25 days vs. 19 days, respectively; p < 0.001). Hospital costs were also significantly higher in the PBS group than in the EBS group (US$126,575 vs. US$89,326, respectively; p < 0.001). The median survival time was 3.7 months in all CC patients, 3.5 months in the PBS group, and 4.0 months in the EBS group. The 1-year, 3-year, and 5-year survival rates were 17.6%, 6.1%, and 3.2% in all CC patients; 16.6%, 4.8%, and 3.2% in the PBS group; and 18.6%, 7.27%, and 3% in the EBS group, respectively. The most important predictor of survival is extrahepatic CC. Medical professionals and healthcare providers should carefully consider the use of EBS for initial treatment of obstructive jaundice in patients with unresectable CC.

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Section: Discussionsupporting

confidence: 91%

Biliary stenting for unresectable cholangiocarcinoma: A population‐based study of long‐term outcomes and hospital costs in Taiwan

Yang

Shi

Huang

et al. 2015

The Kaohsiung J of Med Scie

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“…10,12,13 Of two studies that we identified describing complications, a prospective trial 12 found that 63% had major complications, defined as complications requiring more than one night postprocedure hospitalization, and 31% had minor complications. Two percent died as a result of the procedure, one patient from an arterial bleed and one from sepsis.…”

Section: Resultsmentioning

confidence: 99%

“…Two percent died as a result of the procedure, one patient from an arterial bleed and one from sepsis. The second study, a retrospective analysis, 13 found that patients required a mean of 2.4 procedures and found a 62% incidence of complications, including a 19% incidence of cholangitis; 10% of patients died during the hospitalization for the procedure.…”

Section: Resultsmentioning

confidence: 99%

To Stent or Not to Stent: An Evidence-Based Approach to Palliative Procedures at the End of Life

Harman

Braun

et al. 2012

Journal of Pain and Symptom Management

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Patients near the end of life often undergo invasive procedures, such as biliary stenting for obstructive jaundice, with the intent of relieving symptoms. We describe a case in which the medical team and a patient and family are considering a second palliative biliary stent despite the patient's limited life expectancy. We review available evidence to inform the decision, focusing on the specific question of whether the benefits of palliative biliary stents in patients with advanced cancer outweigh the risks. We then apply the evidence to the issue of how the primary and/or palliative care team and the interventionist communicate with patients and their families about the risks and benefits of palliative procedures. Review of the evidence found several prospective case series without control groups that measured patient-centered outcomes. Studies had high attrition rates, results for improvements in symptoms and quality of life were mixed, and rates of complications and short-term mortality were high. In conclusion, the limited evidence does not support that the benefits of palliative biliary stents in this population outweigh the risks. We propose that primary care teams consider and discuss the larger picture of the goals of care with patients and families when considering offering these procedures, as well as benefits and potential harms, and consider involving palliative care services early, before consultation with an interventionist.

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“…Recurrent biliary obstruction is a major source of morbidity and treatment interruption in patients undergoing chemotherapy. Given the fact that EUSr is associated with a lower rate of recurrent biliary obstruction it stands to reason that this approach would be preferable in patients receiving neoadjunct or palliative chemotherapy 17 18 . Moreover, the length of hospital stay was significantly shorter in the EUSr group, landing another advantage to EUSr; particularly in cases where the initial ERCP is performed on an outpatient basis and if EUSr is performed in the same endoscopic session.…”

Section: Discussionmentioning

confidence: 99%

A comparison between endoscopic ultrasound-guided rendezvous and percutaneous biliary drainage after failed ERCP for malignant distal biliary obstruction

et al. 2016

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Background and study Aims: Selective biliary cannulation is unsuccessful in 5 % to 10 % of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) for malignant distal biliary obstruction (MDBO). Percutaneous biliary drainage (PBD) has been the gold standard, but endoscopic ultrasound guided rendezvous (EUSr) have been increasingly used for biliary decompression in this patient population. Our aim was to compare the initial success rate, long-term efficacy, and safety of PBD and EUSr in relieving MDBO after failed ERC Patients and methods: A retrospective study involving 50 consecutive patients who had an initial failed ERCP for MDBO. Twenty-five patients undergoing EUSr between 2008 – 2014 were compared to 25 patients who underwent PBD immediately prior to the introduction of EUSr at our center (2002 – 2008). Comparisons were made between the two groups with regard to technical success, duration of hospital stay and adverse event rates after biliary decompression. Results: The mean age at presentation was 66.5 (± 12.6 years), 28 patients (54.9 %) were female. The etiology of MDBO was pancreaticobiliary malignancy in 44 (88 %) and metastatic disease in 6 (12 %) cases. Biliary drainage was technically successful by EUSr in 19 (76 %) cases and by PBD in 25 (100 %) (P = 0.002). Median length of hospital stay after initial drainage was 1 day in the EUSr group vs 5 days in PBD group (P = 0.02). Repeat biliary intervention was required for 4 patients in the EUSr group and 15 in the PBD group (P = 0.001). Conclusions: Initial technical success with EUSr was significantly lower than with PBD, however when EUSr was successful, patients had a significantly shorter post-procedure hospital stay and required fewer follow-up biliary interventions.Meeting presentations: Annual Digestive Diseases Week 2015

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Long-Term Results of Percutaneous Transhepatic Cholangiographic Drainage for Palliation of Malignant Biliary Obstruction

Cited by 25 publications

References 7 publications

Biliary stenting for unresectable cholangiocarcinoma: A population‐based study of long‐term outcomes and hospital costs in Taiwan

Biliary stenting for unresectable cholangiocarcinoma: A population‐based study of long‐term outcomes and hospital costs in Taiwan

To Stent or Not to Stent: An Evidence-Based Approach to Palliative Procedures at the End of Life

A comparison between endoscopic ultrasound-guided rendezvous and percutaneous biliary drainage after failed ERCP for malignant distal biliary obstruction

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