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DOI: 10.1055/s-0039-1681869
EVALUATION OF PREDICTORS FACTORS OF FAILURE IN ENDOSCOPIC BILIARY DRAINAGE IN MALIGNANT HILAR BILIARY STRICTURE
Publication History
Publication Date:
18 March 2019 (online)
Aims:
To evaluate the clinical success of biliary drainage by ERCP in patients with primary or secondary malignant hilar biliary stricture and to analyze the predictors factors of failure.
Methods:
This is a retrospective, observational study, in a tertiary oncologic center in Brazil. We included all the patients with malignant hilar biliary stricture (Bismuth ≥ II) submitted to a biliary drainage by ERCP, between January 2010 and December 2017. Clinical success was defined as a decrease in the direct bilirubin level to ≤50% of the pretreatment value within 2 weeks.
Results:
82 patients were included. Bismuth classification grades II, IIIA, IIIB, and IV were noted in 23.2%, 15.9%, 14.6% and 46.3%, respectively. The indication of ERCP was palliative drainage in 56.1%, cholangitis in 29.3% and in previous stent obstruction in 13.4%. About 39% of the patients had a previous stent, 35.4% had plastic stent and 3.7% had metallic stent. The mean direct bilirubin was 8.2 mg/dL.
In 7.3% stent placement technically failed. In 20.7% one hepatic lobe was drainage, in 64.6% more than one lobe was drainage and in 7.3 the stent was placed distal to the confluence of the biliary hepatic branch. The clinical success rate was 53.7%.
The strictures Bismuth IV were related with lower clinical success rate when compared with others strictures (Table 1).
Model and variable |
B (S.E) |
Hazard ratio (95% CI) |
P value |
Biliary strictures Bismuth IV |
1.65 (0.71) |
5.18 (1.28 – 20.88) |
0.021 |
Lobes > 1 lobe |
0.84 (0.67) |
2.31 (0.62 – 8.59) |
0.213 |
Cholangitis Presence |
1.42 (0.85) |
4.15 (0.78 – 22.04) |
0.095 |
Bilirubin levels |
0.07 (0.04) |
1.07 (0.99 – 1.15) |
0.052 |
Conclusions:
Endoscopic biliary drainage for malignant hilar biliary stricture still has limited clinical success rate. The proximal strictures (Bismuth IV) are associated with lower clinical success rate.