Percutaneous vs. endoscopic pre-operative biliary drainage in hilar cholangiocarcinoma – a systematic review and meta-analysis

Hameed, Ahmer; Pang, Tony; Chiou, Judy; Pleass, Henry; Lam, Vincent; Hollands, Michael; Johnston, Emma; Richardson, A. J.; Yuen, Lawrence

doi:10.1016/j.hpb.2016.03.002

Cited by 92 publications

(77 citation statements)

References 44 publications

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“…One previous study did show a significantly higher rate of cholangitis with SOV EBD in surgical patients, but this cohort had a median of 105 days between drainage and surgery, a time period that likely allowed for infectious complications to manifest . A meta‐analysis evaluating biliary drainage in hilar cholangiocarcinoma via percutaneous and endoscopic approaches has, similar to our study, found no significant difference in rates of cholangitis or mortality specifically in the 30 days after intervention …”

Section: Discussionsupporting

confidence: 70%

“…In light of this, biliary drainage represents an important and potentially definitive modality for palliating symptoms of obstructive jaundice . In instances when biliary obstruction remains unrelieved, subsequent cholestasis and cholangitis can considerably impact morbidity . Unfortunately, stenting procedures themselves can be compromised in their therapeutic goals by introducing enteric flora into an otherwise sterile biliary tree .…”

Section: Discussionmentioning

confidence: 99%

“…9,16 In instances when biliary obstruction remains unrelieved, subsequent cholestasis and cholangitis can considerably impact morbidity. 10,17 Unfortunately, stenting procedures themselves can be compromised in their therapeutic goals by introducing enteric flora into an otherwise sterile biliary tree. 10,17 Cholangitis and sepsis are reported to occur following 20% of drainage procedures and can have devastating effects on morbidity and mortality in a patient group with already limited survival.…”

Section: Complications and Violation (Vs Preservation) Of The Sphinctmentioning

confidence: 99%

“…10,17 Unfortunately, stenting procedures themselves can be compromised in their therapeutic goals by introducing enteric flora into an otherwise sterile biliary tree. 10,17 Cholangitis and sepsis are reported to occur following 20% of drainage procedures and can have devastating effects on morbidity and mortality in a patient group with already limited survival. 11,17,18 In addition, further progression of the disease can lead to obstruction of various segments of the biliary tree and incomplete drainage, which is a significant therapeutic challenge particularly in the setting of biliary contamination.…”

Section: Complications and Violation (Vs Preservation) Of The Sphinctmentioning

confidence: 99%

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Postbiliary drainage rates of cholangitis are impacted by procedural technique for patients with supra‐ampullary cholangiocarcinoma: A SEER‐Medicare analysis

Kariya

Wach

Ruff

et al. 2019

Journal of Surgical Oncology

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Background The optimal approach to biliary drainage for patients with supra‐ampullary cholangiocarcinoma remains undetermined. Violation of sphincter of Oddi results in bacterial colonization of bile ducts and may increase postdrainage infectious complications. We sought to determine if rates of cholangitis are affected by the type of drainage procedure. Methods We examined the Surveillance, Epidemiology, and End Results‐Medicare linked database from 1991 to 2013 for cholangiocarcinoma. Biliary drainage procedures were categorized as sphincter of Oddi violating (SOV) or sphincter of Oddi preserving (SOP). Patients were stratified by resection. Results A total of 1914 patients were included in the final analysis. A total of 1264 patients did not undergo a postdrainage resection (SOP 83, SOV 1181) while 650 did undergo a postdrainage resection (SOP 26, SOV 624). For those patients not undergoing a postdrainage resection, the rate of cholangitis 90 days after an SOP procedure was 19% compared with 34% in the SOV cohort (P = 0.007). For those patients undergoing a postdrainage resection, the rate of cholangitis 90 days after an SOP procedure was less than 42.3% compared with 30% in the SOV cohort (P = 0.66). Conclusion For patients with supra‐ampullary cholangiocarcinoma that did not undergo resection, biliary drainage procedures that violated the sphincter of Oddi were associated with increased rates of cholangitis.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Complications and Violation (Vs Preservation) Of The Sphinctmentioning

confidence: 99%

Section: Complications and Violation (Vs Preservation) Of The Sphinctmentioning

confidence: 99%

See 2 more Smart Citations

Postbiliary drainage rates of cholangitis are impacted by procedural technique for patients with supra‐ampullary cholangiocarcinoma: A SEER‐Medicare analysis

Kariya

Wach

Ruff

et al. 2019

Journal of Surgical Oncology

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“…In addition, it has been demonstrated that the icteric liver exhibits reduced tolerance for I/R injury (8,9). However, the majority of cholangiocarcinoma cases coexist with OJ (10).…”

Section: Introductionmentioning

confidence: 99%

Preserving hepatic artery flow during portal triad blood occlusion improves regeneration of the remnant liver in rats with obstructive jaundice following partial hepatectomy

Kong

et al. 2018

Exp Ther Med

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In certain cases, major hepatectomy is essential and inevitable in patients with hilar cholangiocarcinoma and obstructive jaundice (OJ). The current study was designed to evaluate effects of a novel method of portal blood occlusion, where the portal vein was occluded (OPV) and the hepatic artery flow was preserved in rats with OJ that underwent partial hepatectomy. OJ was induced in rats by ligation of the common bile duct for 7 days. Subsequently, OJ rats underwent hepatectomy removing 76% of the liver following occlusion of the portal triad (OPT), OPV or without portal blood occlusion. Liver blood flow (LBF), liver damage and regeneration were assessed. The safety limit for the duration of liver ischemia was 20 min for OPT and 40 min for OPV in rats with OJ. OPT and OPV methods resulted in significantly decreased microvascular LBF in rats with OJ from 529.53±91.55 laser speckle perfusion units (LSPU) in the control to 136.89±32.32 and 183.99±49.25 LSPU, respectively. Liver damage was assessed analyzing levels of serum alanine transaminase and direct bilirubin, determining interleukin-1β and tumor necrosis factor-α expression and histological examination. It was demonstrated that liver damage and caspase-3 and −9 expression in the liver were substantially reduced in the OPV group compared with the OPT group. In addition, the OPV method significantly improved liver regeneration in OJ rats, as indicated by increased rates of liver regeneration and expression of proliferating cell nuclear antigen and Ki-67 compared with the OPT group. Therefore, the OPV method may prolong the duration of portal blood occlusion, reduce liver injury and improve liver regeneration by preserving hepatic arterial flow during portal blood control in rats with OJ undergoing partial hepatectomy. The current study describes a novel technique, which may be applied in liver surgery in patients with complex jaundice.

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Cholangiocarcinoma

Labib

Fusai

Pereira

2019

Evidence‐based Gastroenterology and Hepatology 4e

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Percutaneous vs. endoscopic pre-operative biliary drainage in hilar cholangiocarcinoma – a systematic review and meta-analysis

Abstract: The accepted practice is for most jaundiced HCCA patients to have preoperative drainage of the future liver remnant. EBD may be associated with more immediate procedure-related complications, although it is certainly not inferior compared to PTBD in the long term.

Cited by 92 publications

References 44 publications

Postbiliary drainage rates of cholangitis are impacted by procedural technique for patients with supra‐ampullary cholangiocarcinoma: A SEER‐Medicare analysis

Postbiliary drainage rates of cholangitis are impacted by procedural technique for patients with supra‐ampullary cholangiocarcinoma: A SEER‐Medicare analysis

Preserving hepatic artery flow during portal triad blood occlusion improves regeneration of the remnant liver in rats with obstructive jaundice following partial hepatectomy

Cholangiocarcinoma

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