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Multicenter study of endoscopic preoperative biliary drainage for malignant hilar biliary obstruction: E‐POD hilar study
Author(s) -
Nakai Yousuke,
Yamamoto Ryuichi,
Matsuyama Masato,
Sakai Yuji,
Takayama Yukiko,
Ushio Jun,
Ito Yukiko,
Kitamura Katsuya,
Ryozawa Shomei,
Imamura Tsunao,
Tsuchida Kouhei,
Hayama Jo,
Itoi Takao,
Kawaguchi Yoshiaki,
Yoshida Yu,
Sugimori Kazuya,
Shimura Kenji,
Mizuide Masafumi,
Iwai Tomohisa,
Nishikawa Ko,
Yagioka Hiroshi,
Nagahama Masatsugu,
Toda Nobuo,
Saito Tomotaka,
Yasuda Ichiro,
Hirano Kenji,
Togawa Osamu,
Nakamura Kenji,
Maetani Iruru,
Sasahira Naoki,
Isayama Hiroyuki
Publication year - 2018
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14050
Subject(s) - medicine , biliary drainage , radiology , biliary tract , multicenter study , endoscopy , gastroenterology , general surgery , randomized controlled trial
Background and Aim Endoscopic nasobiliary drainage (ENBD) is often recommended in preoperative biliary drainage (PBD) for hilar malignant biliary obstruction (MBO), but endoscopic biliary stent (EBS) is also used in the clinical practice. We conducted this large‐scale multicenter study to compare ENBD and EBS in this setting. Methods A total of 374 cases undergoing PBD including 281 ENBD and 76 EBS for hilar MBO in 29 centers were retrospectively studied. Results Extrahepatic cholangiocarcinoma (ECC) accounted for 69.8% and Bismuth–Corlette classification was III or more in 58.8% of the study population. Endoscopic PBD was technically successful in 94.6%, and adverse event rate was 21.9%. The rate of post‐endoscopic retrograde cholangiopancreatography pancreatitis was 16.0%, and non‐endoscopic sphincterotomy was the only risk factor (odds ratio [OR] 2.51). Preoperative re‐intervention was performed in 61.5%: planned re‐interventions in 48.4% and unplanned re‐interventions in 31.0%. Percutaneous transhepatic biliary drainage was placed in 6.4% at the time of surgery. The risk factors for unplanned procedures were ECC (OR 2.64) and total bilirubin ≥ 10 mg/dL (OR 2.18). In surgically resected cases, prognostic factors were ECC (hazard ratio [HR] 0.57), predraiange magnetic resonance cholangiopancreatography (HR 1.62) and unplanned re‐interventions (HR 1.81). EBS was not associated with increased adverse events, unplanned re‐interventions, or a poor prognosis. Conclusions Our retrospective analysis did not demonstrate the advantage of ENBD over EBS as the initial PBD for resectable hilar MBO. Although the technical success rate of endoscopic PBD was high, its re‐intervention rate was not negligible, and unplanned re‐intervention was associated with a poor prognosis in resected hilar MBO.