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Percutaneous transhepatic biliary drainage may be the preferred preoperative drainage method in hilar
Yongjiang Ba1,2,3, Ping Yue1,2,4,5,6, Joseph W Leung7
1The First Clinical Medical School of Lanzhou University, Lanzhou, China.
Insights
Percutaneous transhepatic biliary drainage (PTBD) is a safer and more cost-effective method than endoscopic retrograde cholangiopancreatography (ERCP) for preoperative biliary drainage in hilar cholangiocarcinoma (HC) types II-IV. PTBD significantly reduced complications like cholangitis and pancreatitis.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Interventional Radiology
Background:
- Preoperative biliary drainage for hilar cholangiocarcinoma (HC) remains a subject of debate.
- Management of HC types II, III, and IV presents unique challenges in biliary decompression.
Purpose of the Study:
- To compare the clinical outcomes and complications of percutaneous transhepatic biliary drainage (PTBD) versus endoscopic retrograde cholangiopancreatography (ERCP) for HC types II-IV.
- To evaluate the efficacy and safety of different drainage techniques in managing HC.
Main Methods:
- A retrospective cohort study involving 180 patients with HC types II, III, and IV.
- Patients were divided into two groups: PTBD (n=81) and ERCP (n=99).
- Clinical outcomes, including post-procedural cholangitis, pancreatitis, need for salvage drainage, and costs, were analyzed.
Main Results:
- The ERCP group exhibited higher rates of post-procedural cholangitis (37.37% vs. 22.22%) and pancreatitis (17.17% vs. 2.47%) compared to the PTBD group.
- ERCP also required more salvage biliary drainage (18.18% vs. 6.17%) and incurred higher hospitalization costs.
- Patients with type III and IV HC in the ERCP group had significantly more cholangitis than in the PTBD group (36.62% vs. 18.03%).
Conclusions:
- PTBD is associated with a lower incidence of cholangitis, pancreatitis, and need for salvage biliary drainage compared to ERCP for HC types II-IV.
- PTBD also leads to reduced hospitalization costs.
- The risk of cholangitis is significantly lower with PTBD for patients with type III and IV HC.
Abstract:
Background and study aims Preoperative biliary drainage of hilar cholangiocarcinoma (HC) is controversial. The goal of this study was to compare the clinical outcome and associated complications for types II, III, and IV HC managed by percutaneous transhepatic biliary drainage (PTBD) and endoscopic retrograde cholangiopancreatography (ERCP). Patients and methods Between January 2011 and June 2017, a total of 180 patients with II, III, and IV HC were enrolled in this retrospective cohort study. According to the drainage method, patients were divided into two groups: PTBD (n = 81) and ERCP (n = 99). This study was registered with ClinicalTrials.gov, NCT03104582, and was completed. Results Compared with the PTBD group, the ERCP group had a higher incidence of post-procedural cholangitis (37 [37.37 %] vs. 18 [22.22 %], P = 0.028) and pancreatitis (17 [17.17 %] vs. 2 [2.47 %], P = 0.001); required more salvaged biliary drainage (18 [18.18 %] vs. 5 [6.17 %], P = 0.029), and incurred a higher cost ( P < 0.05). Patients with type III and IV HC in the ERCP group had more cholangitis than those in the PTBD group (26 [36.62 %] vs. 11 [18.03 %], P = 0.018). The rate of cholangitis in patients who received endoscopic bilateral biliary stents insertion was higher than patients with unilateral stenting (23 [50.00 %] vs. 9 [26.47 %], P = 0.034), and underwent PTBD internal-external drainage had a higher incidence of cholangitis than those with only external drainage (11 [34.36 %] vs. 7 [14.29 %], P = 0.034). No significant difference in the rate of cholangitis was observed between the endoscopic unilateral stenting group and the endoscopic nasobiliary drainage group (9 [26.47 %] vs. 5 [26.32 %], P = 0.990). Conclusion Compared to ERCP, PTBD reduced the rate of cholangitis, pancreatitis, salvage biliary drainage, and decreased hospitalization costs in patients with types II, III, and IV HC. Risk of cholangitis for patients with types III and IV was significantly lower in the PTBD group.
