Premium
Congested bile can predict the outcomes of endoscopic stenting for hilar biliary malignancies
Author(s) -
Xia Ming Xing,
Sun Bo,
Xing Ling,
Gao Dao Jian,
Ye Xin,
Wu Jun,
Wang Tian Tian,
Hu Bing
Publication year - 2017
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.12555
Subject(s) - medicine , endoscopic retrograde cholangiopancreatography , stent , retrospective cohort study , jaundice , gastroenterology , surgery , pancreatitis
OBJECTIVE Endoscopic management of malignant hilar biliary obstruction (MHBO) remains challenging, with relatively poor jaundice control and high infectious risk. The factors that affect the outcome of endoscopic therapy are still unclear. This retrospective cohort study aimed to investigate predictive factors for the outcomes of biliary stenting in patients with MHBO. METHODS Between June 2015 and June 2016, consecutive patients with MHBO who received primary endoscopic stenting and completed follow‐up at our institution were identified and evaluated. All patients received full aspiration of congested bile followed by plastic or metal stent(s) placement. Clinical success was achieved in patients whose total serum bilirubin decreased by over two‐thirds in a month. RESULTS A total of 64 patients were included. Among them, 28 received a single stent placement and 36 received multiple stent placements. Altogether 53 (82.8%) patients attained clinical success and 48 (75.0%) underwent re‐interventions within 6 months. Multivariate analyses showed that only a total bile volume of ≥30 mL aspirated from the intrahepatic ducts predicted clinical success (OR 6.83, 95% CI 1.2–38.4, P = 0.029), absence of early post‐endoscopic retrograde cholangiopancreatography cholangitis (OR 0.03, 95% CI 0.004–0.36, P = 0.001), and lack of re‐intervention within 6 months (HR 0.10, 95% CI 0.05–0.22, P < 0.001) after initial endoscopic stenting. CONCLUSION The volume of congested bile may effectively predict treatment outcomes of endoscopic stenting for MHBO and guide the therapeutic strategy.