ENDOSCOPIC DRAINAGE IN PATIENTS WITH HILAR CHOLANGIOCARCINOMA BISMUTH IV

Aims Evaluate the endoscopic drainage in patients with hilar cholangiocarcinoma (CCK) bismuth IV using metallic stents (MS) and plastic stents (PS) versus percutaneous approach.

Methods This is a retrospective study including all patients who had endoscopic retrograde cholangiopancreatography (ERCP) for Bismuth IV CCK between March 2017 and November 2021, parameters evaluated : technical success, efficacity of drainage, complication rate, stent patency and survival.

Results 13pts were included, the technical success was 77% (n=10), effective in 7 patients (53.83%). Unilateral biliary drainage was performed in 11 patients (84.61%) including 8 PS (72.7%) and 3 MS (27.2%). patients who had PS, 6 of them (46.14%) required a stent change and 2 patients (15.38%) required second stent. Complications such as migration and stent obstruction occurred in 5% in case of PS and (0.3%) in case of a MS. The median duration of stent patency was 3.8 months in patients treated with PS and 6.5 months in patients treated with MS. For unilateral and bilateral stent placement, the median PS patency time was 19 weeks and 21 weeks, respectively. For unilateral MS placement, the median patency time was 36 weeks. Percutaneous drainage was performed in 30.76% with an estimated technical success of 75%. Median duration of drain was 3weeks. The median survival with successful endoscopic biliary drainage was 6.5 months, 8.2 months in successful percutaneous drainage.

Conclusions The endoscopic approach in bismuth IV cholangiocarcinoma is the treatment of choice despite the technical difficulties, it improves quality of life with lower complication rates and a superior cumulative stent patency.

Publication History

Article published online:
14 April 2022