Endoscopy 2022; 54(S 01): S83
DOI: 10.1055/s-0042-1744759
Abstracts | ESGE Days 2022
ESGE Days 2022 Oral presentations
17:00–18:00 Friday, 29 April 2022 Club H. Biliary strictures and stenting: what’s new

A PROPENSITY MATCHED RETROSPECTIVE STUDY ON PREOPERATIVE BILIARY DRAINAGE IN PATIENTS WITH RESECTABLE PERIHILAR CHOLANGIOCARCINOMA: METAL BEATS PLASTIC STENTS?

D.M. de Jong
1   Erasmus University Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
,
L.E. Nooijen
2   Amsterdam UMC, Department of Surgery, Amsterdam, Netherlands
,
T.M. Gilbert
3   University Hospital Aintree, Department of Surgery, Liverpool, United Kingdom
,
E. Braunwarth
4   Medical University of Innsbruck, Department of Surgery, Innsbruck, Austria
,
M. Ninkovic
4   Medical University of Innsbruck, Department of Surgery, Innsbruck, Austria
,
F. Primavesi
4   Medical University of Innsbruck, Department of Surgery, Innsbruck, Austria
,
H.Z. Malik
3   University Hospital Aintree, Department of Surgery, Liverpool, United Kingdom
,
N. Stern
5   Aintree University Hospitals NHS Foundation Trust, Digestive Diseases Unit, Liverpool, United Kingdom
,
R. Sturgess
5   Aintree University Hospitals NHS Foundation Trust, Digestive Diseases Unit, Liverpool, United Kingdom
,
J.I. Erdmann
2   Amsterdam UMC, Department of Surgery, Amsterdam, Netherlands
,
R.P. Voermans
6   Amsterdam UMC, Department of Gastroenterology and Hepatology, Amsterdam, Netherlands
,
M.J. Bruno
1   Erasmus University Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
,
B. Groot Koerkamp
7   Erasmus University Medical Center, Department of Surgery, Rotterdam, Netherlands
,
L.M. van Driel
1   Erasmus University Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
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Aims Adequate preoperative biliary drainage (PBD) is important in patients with resectable perihilar cholangiocarcinoma (pCCA). Currently, Uncovered self-expanding metal stents (SEMS) are not recommended due to potential difficult surgical removal. However, SEMS have proven their advantage in the palliative setting showing a much longer patency and even survival. The aim of this study is to compare the efficacy of PBD with SEMS versus plastic stents (PS) in relation to surgical outcome in resectable pCCA patients.

Methods In this retrospective, multicenter, international cohort study, patients with high suspicion of resectable pCCA who underwent ERCP as initial method to obtain PBD were included from 2010-2020. Efficacy was defined as stent failure, e.g. a composite endpoint of cholangitis and/or re-intervention due to complications or inadequate PBD. Other complications, surgical outcomes and survival were recorded. Propensity score matching (PSM) was performed to adjust for potential confounders.

Results 474 patients had successful stent placement, of which 83 received SEMS and 391 PS, after PSM (n=81). Stent failure occurred significantly less in the SEMS group (28% vs 67%, p<0.001). However, the number of patients undergoing curative intent surgery was similar. Other stent-related complications were alike. Complete SEMS removal during surgery was successful and without complications. Post-operative outcomes and survival were comparable, except for significantly more hepaticojejunostomy leaks in the PS group.

Table 1

SEMS (n=81)

Plastic (n=81)

P-value

Stent failure

23 (28%)

54 (67%)

<0.001

Curative intent surgery

39 (57%)

42 (59%)

0.965

90-day mortality

8 (21%)

8 (19%)

1.000

Hepaticojejunostomy leak

2 (5%)

9 (21%)

0.049

Conclusions SEMS shows superior drainage characteristics compared to PS in patients with resectable pCCA and removal during surgery was well feasible. Surgical outcomes were comparable. Prospective studies are needed to confirm this promising data on PBD by SEMS.



Publication History

Article published online:
14 April 2022

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