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Updated: Aug 6, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
The role of endoscopic biliary drainage in access to systemic chemotherapy in patients with malignant biliary
Grzegorz Boryczka1, Marek Hartleb1, Małgorzata Janik2
1Department of Gastroenterology and Hepatology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Poland.
Introduction:
Endoscopic drainage is the standard of care in patients with malignant biliary obstruction (MBO).
Aim:
The aim of this study was to investigate the efficacy of biliary stenting in providing access to systemic chemotherapy.
Material And Methods:
Patients with bile duct obstruction (bilirubin > 2.5 mg/dl) caused by unresectable biliary or pancreatic cancer were retrospectively analysed with respect to use of chemotherapy and survival. Laboratory data were analysed at baseline, 7-10, and 28-35 days following biliary stenting.
Results:
Patients with MBO (n = 78) were allocated into one of three groups according to baseline bilirubin level [mg/dl]: 2.5-5.99 (1), 6.0-15.0 (2), and > 15 (3). At the first test, the mean bilirubin decrease from baseline in the respective groups was as follows: 1.19 (29.5%), 3.77 (38.5%), 7.1 (27.3%), and at the second measurement: 1.61 (40%), 5.69 (58.2%), 13.0 (50%), respectively. Chemotherapy was applied in 28 (35.8%) patients, less frequently in group 3 than in 1 (31.2% vs. 44.0%; p = 0.07) and 2 (vs. 38.1%; p = 0.06). The mean survival time was 4.8 ±2.8 months and was significantly shorter in group 3 than in group 2 (3.8 ±2.0 vs. 6.2 ±3.9 months; p = 0.02) and 1 (vs. 5.4 ±2.7 months; p = 0.03).
Conclusions:
In two-thirds of patients with MBO, endoscopic biliary drainage does not secure access to chemotherapy. The use of chemotherapy and survival time are significantly higher in patients with a bilirubin level below 15 mg/dl as compared to those with higher bilirubinaemia, but biliary drainage is only minimally effective in patients with a bilirubin level below 6 mg/dl.
