Related Experiment Video
Updated: Sep 6, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Should We Be Aiming For A "Stent-first Strategy" in the Management of Malignant Biliary Obstruction? A Retrospective
Rathna B Veerni1, Sana Sheykhzadeh1, Alexander Valentinov Jordanov1
1Department of Clinical Radiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK.
Abstract:
BackgroundPercutaneous transhepatic cholangiography (PTC) is essential when endoscopic retrograde cholangiopancreatography (ERCP) fails or is contraindicated. Despite emerging evidence favoring primary stenting, data directly comparing it with the traditional two-staged drainage approach remain scarce.PurposeTo evaluate the efficacy, complication rates, and reintervention burden of initial stent placement versus drainage.Material and MethodsA retrospective single-center analysis of 96 patients undergoing PTC (2021-2024) was conducted; 95 received intervention (primary stent n = 30, drain n = 65). Outcomes (bilirubin kinetics, clinical success, complications, reinterventions) were compared using Welch's t-test, chi-square test, or Fisher's exact test, with multivariable adjustment for baseline differences.ResultsMalignant obstruction accounted for 96.8% of cases; technical success was 97.9% (CIRSE standards). Bilirubin reduction was greater with stents (45.7% vs. 35.5%; mean difference 10.2 percentage points, 95% confidence interval = 0.3-20.0; P = 0.043), attenuated after adjustment (β = 9.8 pp; P = 0.093). Complications, all reinterventions, and combined adverse events were lower with stents (23.3% vs. 55.4%, 16.7% vs. 73.8%, and 30.0% vs. 86.2%; all P ≤0.004); adjusted analyses confirmed independently reduced odds (adjusted odds ratio = 0.26, 0.08, and 0.07, respectively). Clinical success trended higher with stents (46.7% vs. 38.5%) but was not statistically significant. Overall, 30-day mortality was 17.7% with 2% procedure-related. Median post-intervention survival was 101 days.ConclusionIn this retrospective single-center cohort, a stent-first approach was associated with greater bilirubin reduction and fewer complications and reinterventions than drainage-first, without compromising technical success or survival. Findings are hypothesis-generating and require prospective multicenter validation.