NUMBER OF STENTS PREDICTS THE RISK OF ACUTE PANCREATITIS AND EARLY COMPLICATIONS IN HILAR BILIARY DRAINAGE: SUGGESTIONS FROM A LARGE SINGLE CENTER STUDY

Aims In case of malignant hilar biliary stenosis, endoscopic retrograde cholangiography (ERCP), percutaneous-biliary drainage (PTBD) and endoscopic ultrasound biliary drainage (EUS-BD), can ensure a good biliary drainage, which is crucial for survival. The aim of this study was to evaluate the complications risk factors of these drainages.

Methods Retrospective study from a prospective registry of malignant biliary stenosis drained in a single center. The primary outcome was the postoperative complication rate during the first month after drainage, with a focus on acute pancreatitis.

Results 198 patients (121 males, mean age 69 years) with malignant hilar stenosis due to CCK (42%), metastatic colon cancer (24%), pancreatic cancer (10%), other (24%) were included. Hilar stenosis was type II in 48 pts, IIIA in 32, IIIB in 9, IV in 109. The characteristics of endoscopic procedures are summarized in table 1. Postoperative complications occurred in 87 pts (44%), with pancreatitis in 21 pts (11%), cholangitis in 29 (15%) sepsis and bleeding in 11 (6%). At univariate logistic regression, stent number (1-2 vs ≥3 stents) was predictor of both overall early complication (39% vs 60%; OR 2.42 95% CI 1.25-4.71 p=0.009) and pancreatitis

(8% vs 19%; OR 2.65, 95% CI 1.04-6.77, p=0.04).

Tab. 1 Characteristics of endoscopic procedures

Type of drainage, n (%)	ERCP: 128 (65%), PTBD: 6 (3%), EUS: 8 (4%), ERCP+PTBD: 24 (12%), ERCP+EUS: 18 (9%), PTBD+EUS: 6 (3%), ERCP+EUS+PTBD: 8 (4%)
Number of stent placed, n (%)	1: 52 (26%), 2: 98 (49%), 3: 36 (18%), 4: 11 (6%), 5: 1(1%)
Endoscopic sessions required, n (%)	1: 82%, 2:16%, 3:2%
Type of stent, n (%)	Plastic: 40 (20%); Metallic: 158 (80%); External drain: 32 (16%)

Conclusions In complex hilar biliary drainage, placing three or more stents seems to increase the risk of pancreatitis and overall postoperative complications.