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.
