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

Keulen, Anne-Marleen van; Gaspersz, M.; Vugt, Jeroen L.A. van; Roos, Eva; Olthof, Pim B.; Coelen, R.J.; Bruno, Marco J.; Driel, Lydi M.J.W. van; Voermans, Rogier P.; Eijck, Casper H.J. van; Hooft, Jeanin E. van; Lienden, Krijn P. van; Jonge, Jeroen de; Polak, Wojciech; Poley, Jan–Werner; Pek, Chulja J.; Moelker, Adriaan; Willemssen, F.; Gulik, Thomas M. van; Erdmann, Joris I.; Hol, Lieke; IJzermans, Jan N.M.; Büttner, Stefan; Koerkamp, B. Groot

doi:10.1016/j.surg.2022.06.028

Cited by 3 publications

(2 citation statements)

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“…The rate of technical success was in general lower for perihilar (70.6%) and multiple level (52.8%) MBO compared to distal MBO (85.4%), which is in accordance with available data [21,22]. However, our rate of technical success is comparable to others [23]. Recent reports indicate that for distal MBO, difficult biliary cannulation (DBC) can be an underestimated problem [21].…”

Section: Discussionsupporting

confidence: 91%

ERCP for the initial management of malignant biliary obstruction – real world data on 596 procedures

Breder,

Mikalsen,

Medhus

et al. 2023

ESGE Days 2023

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Aims:To evaluate outcomes of ERCP as first-line management in patients with malignant biliary obstruction (MBO) of all causes and stages, reflecting a real-life setting. Methods: Retrospective observational study of patients with ERCP as the first-line management of MBO at Oslo University Hospital between 2015 and 2021. Primary outcome measure was a ≥ 50% decrease from the pre-procedural bilirubin within 30 days after ERCP. Secondary outcome measures were technical success of ERCP, complications and overall mortality. Results: A total of 596 patients were included, median age 70 years. ASA score was ≥ III in 67% of patients. The most common cancers causing MBO were pancreatic cancer (52%), metastatic lesions (20%) and cholangiocarcinoma (16%). The primary outcome measure was achieved in 62% of patients. With endoscopic access, overall technical success was 80% with 85% for the distal extrahepatic group, 71% for the perihilar, 40% for the intrahepatic and 53% for multiple level MBOs. Reinterventions were performed in 27% of the patients. Complications occurred in 15% of the patients, including post-ERCP pancreatitis in 9%. Most complications were of minor/moderate severity (81%). Overall mortality was 33% within the first 90 days. Patients deceased by the end of the study period (83%) had median survival of 146 days (range 1-2,582 days). Conclusions: ERCP has a high rate of clinical effect and technical success in the management of both distal extrahepatic and perihilar MBO. Our data indicate that ERCP is a valid option in the first-line management of MBO.

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Section: Discussionsupporting

confidence: 91%

ERCP for the initial management of malignant biliary obstruction – real world data on 596 procedures

Breder,

Mikalsen,

Medhus

et al. 2023

ESGE Days 2023

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“…In pCCA progressive disease is typically detrimental to performance status and disease-and drainage-related mortality is high in the first months after diagnosis [9]. Because of biliary complications and disease progression, about one-third of the initial presumed resectable patients do not make it to surgical exploration.…”

Section: Introductionmentioning

confidence: 99%

National consensus on a new resectability classification for perihilar cholangiocarcinoma - A modified Delphi method

Nooijen,

de Boer,

Braat

et al. 2023

European Journal of Surgical Oncology

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ERCP for the initial management of malignant biliary obstruction – real world data on 596 procedures

Mikalsen,

Breder,

Medhus

et al. 2023

Scandinavian Journal of Gastroenterology

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

Cited by 3 publications

References 38 publications

ERCP for the initial management of malignant biliary obstruction – real world data on 596 procedures

ERCP for the initial management of malignant biliary obstruction – real world data on 596 procedures

National consensus on a new resectability classification for perihilar cholangiocarcinoma - A modified Delphi method

ERCP for the initial management of malignant biliary obstruction – real world data on 596 procedures

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