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Comparative Study
. 2010 Jan;14(1):119-25.
doi: 10.1007/s11605-009-1009-1. Epub 2009 Sep 15.

Endoscopic and percutaneous preoperative biliary drainage in patients with suspected hilar cholangiocarcinoma

Jaap J Kloek  1 , Niels A van der Gaag, Yalda Aziz, Erik A J Rauws, Otto M van Delden, Johan S Lameris, Olivier R C Busch, Dirk J Gouma, Thomas M van Gulik
Affiliations
Comparative Study

Endoscopic and percutaneous preoperative biliary drainage in patients with suspected hilar cholangiocarcinoma

Jaap J Kloek et al. J Gastrointest Surg. 2010 Jan.

Abstract

Introduction: Controversy exists over the preferred technique of preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCCA) requiring major liver resection. The current study compared outcomes of endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) in patients with resectable HCCA.

Methods: One hundred fifteen consecutive patients were explored for HCCA between 2001 and July 2008 and assigned by initial PBD procedure to either EBD or PTBD.

Results: Of these patients, 101 (88%) underwent PBD; 90 patients underwent EBD as primary procedure, and 11 PTBD. The technical success rate of initial drainage was 81% in the EBD versus 100% in the PTBD group (P = 0.20). Stent dislocation was similar in the EBD and PTBD groups (23% vs. 20%, P = 0.70). Infectious complications were significantly more common in the endoscopic group (48% vs. 9%, P < 0.05). Patients in the EBD group underwent more drainage procedures (2.8 vs. 1.4, P < 0.01) and had a significantly longer drainage period until laparotomy (mean 15 weeks vs. 11 weeks in the PTBD group; P < 0.05). In 30 patients, EBD was converted to PTBD due to failure of the endoscopic approach.

Conclusions: Preoperative percutaneous drainage could outperform endoscopic stent placement in patients with resectable HCCA, showing fewer infectious complications, using less procedures.

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Figures

Figure 1
Figure 1
Flow chart of patients eligible for resection of hilar cholangiocarcinoma (HCCA) in the period from January 2001 to July 2008.
See this image and copyright information in PMC

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