Endoscopic biliary drainage in the palliative treatment of Klatskin tumors: outcomes and factors associated with success or failure

Aims Klatskin tumor is a cholangiocarcinoma that develops fromthe right or left bile ducts and the upper part of the common bile duct(CBD). They are usually diagnosed at an advanced inoperable stage, and theirprognosis is extremely poor. Biliary drainage is proposed in palliative situations andcarries a high risk of infectious complications.The aim of our work is to report the results of endoscopic biliary drainageas well as the factors associated with its success or failure.

Methods This is a retrospective and analytical study collecting 75 patients,conducted between July 2011 and August 2023, including all patients admitted for a Klatskin tumor and whose indication for endoscopic drainage was established.The factors associated with the success or failure of endoscopic treatment were studied by logistic regression analysis.The statistical analysis was performed by SPSS software version 22.0

Results The mean age of our patients was 62.67+/-12 years with extremes rangingfrom 31 to 93 years.Our series was characterized by a male predominance of 68%, a sex ratio of 2.12.Cholangiocarcinoma was classified as bismuth IV in 50.6% of patients, bismuth IIIa in 30% of patients, bismuth IIIb in 13% of patients, and bismuth II in 6% of patients. Sixteen percent of patients had liver metastases.Endoscopic drainage was successfully performed in 81.3% of patients by a plastic stent in 32% of cases (n=24), by a metallic stent in 45.2% cases (n=34), and by nasobiliary drain in 4.1% cases (n=3). Forty-seven percent of patients (n=35)benefited from dilation of the stenosis before placement of the stent. The causes of failure of prosthesis placement were mainly related to failure of papilla catheterization, failure of guidewire passage through the stenosis, or duodenal invasion by the tumor.In multivariate analysis and adjusting for the parameters studied, namely age, sex, type of tumor according to the Bismuth classification, presence of metastases and endoscopic dilatation of the stenosis, only the presence of metastases, endoscopic dilatation of the stenosis and type of tumor according to the Bismuth classification modified the success rate.Indeed, endoscopic dilatation of the stenosis before prosthesis placement multiplied the success rate by 4 [OR=4; p=0.01], while the presence of metastases reduced this rate by 65% ​​[OR=0.35; p=0.001]. However, tumors classified as Bismuth IV [OR=8; p=0.001] or Bismuth IIIa [OR=5; p=0.004] were associated with a risk of failure of endoscopic treatment.

Conclusions Our study suggests that the presence of metastases, hilar cholangiocarcinoma classified as Bismuth IV or Bismuth IIIa seem to be associated with the failure of endoscopic biliary drainageof Klatskin tumors while endoscopic dilatation before placement of thestent seems to be associated with its success.

Publication History

Article published online:
27 March 2025