Endoscopy 2018; 50(04): S195
DOI: 10.1055/s-0038-1637640
ESGE Days 2018 ePosters
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC BILIARY DRAINAGE IN PERIHILAR CHOLANGIOCARCINOMA- RESULTS OF AN OBSERVATIONAL SINGLE-CENTER STUDY

T Voiosu
1   Colentina Clinical Hospital, Gastroenterology, Bucharest, Romania
2   UMF Carol Davila School of Medicine, Internal Medicine Department, Bucharest, Romania
,
C Mocanu
3   Cantacuzino Hospital, Gastroenterology, Bucharest, Romania
,
B Busuioc
3   Cantacuzino Hospital, Gastroenterology, Bucharest, Romania
,
A Voiosu
4   Colentina Clinical Hospital, Gastroenterology Division, Bucharest, Romania
,
A Gheorghe
4   Colentina Clinical Hospital, Gastroenterology Division, Bucharest, Romania
,
M Rimbas
4   Colentina Clinical Hospital, Gastroenterology Division, Bucharest, Romania
,
C Iacob
2   UMF Carol Davila School of Medicine, Internal Medicine Department, Bucharest, Romania
,
A Benguş
4   Colentina Clinical Hospital, Gastroenterology Division, Bucharest, Romania
,
B Mateescu
2   UMF Carol Davila School of Medicine, Internal Medicine Department, Bucharest, Romania
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Publikationsverlauf

Publikationsdatum:
27. März 2018 (online)

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Aims:

Biliary drainage in patients with perihilar cholangiocarcinoma is a challenging procedure, especially in cases with complex strictures (type Bismuth-Corlette III or IV), with suboptimal results and high complication rates cited in the literature. We aimed to assess technical success and procedure related complications in these cases.

Methods:

This is a retrospective analysis of prospectively collected data from an ongoing study of technical outcomes of ERCPs. We selected all patients diagnosed with perihilar cholangiocarcinoma and Bismuth-Corlette type III/IV strictures where endoscopic drainage was attempted. Technical outcome (successful stenting), number and type of stents (uni versus bilateral stenting, plastic versus metal stents) and use of dilation before stent insertion (either with Soehendra bougies or balloon dilation) were analyzed. Procedure related adverse events were also reported.

Results:

430 consecutive ERCPs performed at Colentina Clinical Hospital were reviewed and 45 ERCPs in patients with perihilar cholangiocarcinoma were included in the final analysis. The attempted procedure was technically successful in 28/35 cases on the first attempt (82.3%) and in 7/11 cases on the second attempt, with an overall success rate of 77,7% per procedure. Out of the 37 procedures where stenting was successful, unilateral stenting was carried out in 20 patients (54%) and bilateral stenting achieved in 17 cases (46%). Plastic stents were more frequently used (31/45) compared to self-expanding metal stents which were used in 6 cases (16.3%). Stricture dilation was carried out in 18 cases (40%), using Soehendra bougie dilators in most cases (17/18) compared to balloon dilation (1/18). Early complications developed in 14 cases (31%), distributed as follows: cholangitis (20%), pancreatitis (4.4%), bleeding (4.4%) and cholecystitits (2,2%). All the complications were graded as either mild or moderate according to consensus guidelines.

Conclusions:

Biliary drainage for Bismuth III/IV strictures is a highly demanding endoscopic technique, with a high rate of technical failure and procedure-related adverse events.