Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar;9(1):e000878.
doi: 10.1136/bmjgast-2022-000878.

Factors predicting 30-day mortality after ERCP in patients with inoperable malignant hilar biliary obstruction: a single tertiary referral centre experience and systematic review

Wei On  1 , Muhammad A Saleem  2 , Vinod S Hegade  3 , Matthew T Huggett  2 , Bharat Paranandi  2 , Simon M Everett  2
Affiliations

Factors predicting 30-day mortality after ERCP in patients with inoperable malignant hilar biliary obstruction: a single tertiary referral centre experience and systematic review

Wei On et al. BMJ Open Gastroenterol. 2022 Mar.

Abstract

Objective: There is a paucity of studies in the literature body evaluating short term outcomes following endoscopic retrograde cholangiopancreatography (ERCP) in patients with inoperable malignant hilar biliary obstruction (MHBO). We aimed to primarily evaluate 30-day mortality in these patients and secondarily, conduct a systematic review of studies reporting 30-day mortality.

Design: We conducted a retrospective analysis of all patients with inoperable MHBO who underwent ERCP at Leeds Teaching Hospitals NHS Trust between February 2015 and September 2020. Logistic regression models constructed from baseline patient data, the modified Glasgow Prognostic Score (mGPS) and Charlson Comorbidity Index (CCI) were evaluated as predictors of 30-day mortality.

Results: Eighty-seven patients (49 males) with a mean age of 70.4 years (SD ±12.3) were included. Cholangiocarcinoma was the most common aetiology of MHBO affecting 35/87 (40.2%). Technical success was achieved in 72/87 (82.8%). The 30-day mortality rate was 25.3% (22/87), of which 16 were due to progression of underlying malignant disease. On multivariate analysis, only leucocytosis (OR 4.12, 95% CI 2.70 to 7.41, p=0.02) was an independent predictor of 30-day mortality. Neither mGPS (p=0.47) nor CCI with a cut-off value of ≥7 (p=0.06) were significant predictors of 30-day mortality.

Conclusion: We demonstrated that 30-day mortality following ERCP for inoperable MHBO remains high despite technical success. Further studies are warranted to identify patients most appropriate for intervention.

Keywords: BILIARY ENDOSCOPY; BILIARY STRICTURES; CHOLANGIOCARCINOMA.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart depicting selection of articles for systematic review. ** Non-relevant articles.
Figure 2
Figure 2
Flow chart depicting selection process for inclusion of patients. ERCP, endoscopic retrograde cholangiopancreatography; PTC, percutaneous transhepatic cholangiogram.
Figure 3
Figure 3
Kaplan-Meier plots demonstrating survival. (A) 30-day survival in relation to mGPS. (B) 30-day survival in relation to CCI. CCI, Charlson Comorbidity Index; mGPS, modified Glasgow Prognostic Score.
See this image and copyright information in PMC

References

    1. Aljiffry M, Walsh MJ, Molinari M. Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009. World J Gastroenterol 2009;15:4240–62. 10.3748/wjg.15.4240 - DOI - PMC - PubMed
    1. Salgado SM, Gaidhane M, Kahaleh M. Endoscopic palliation of malignant biliary strictures. World J Gastrointest Oncol 2016;8:240–7. 10.4251/wjgo.v8.i3.240 - DOI - PMC - PubMed
    1. Park DH. Endoscopic ultrasound-guided biliary drainage of hilar biliary obstruction. J Hepatobiliary Pancreat Sci 2015;22:664–8. 10.1002/jhbp.271 - DOI - PubMed
    1. Harvey PR, Baldwin S, Mytton J, et al. . Higher volume providers are associated with improved outcomes following ERCP for the palliation of malignant biliary obstruction. EClinicalMedicine 2020;1810.1016/j.eclinm.2019.11.005 - DOI - PMC - PubMed
    1. Rees J, Mytton J, Evison F, et al. . The outcomes of biliary drainage by percutaneous transhepatic cholangiography for the palliation of malignant biliary obstruction in England between 2001 and 2014: a retrospective cohort study. BMJ Open 2020;10:e033576. 10.1136/bmjopen-2019-033576 - DOI - PMC - PubMed

Publication types