Yonsei Med J.  2014 Sep;55(5):1267-1272. 10.3349/ymj.2014.55.5.1267.

The Efficacy of Endoscopic Palliation of Obstructive Jaundice in Hepatocellular Carcinoma

• Park S
• Park JY
• Chung MJ
• Chung JB
• Park SW
• Han KH
• Song SY
• Bang S

• KMID: 1799490
• DOI: http://doi.org/10.3349/ymj.2014.55.5.1267

Abstract

PURPOSE
Obstructive jaundice in patients with hepatocellular carcinoma (HCC) is uncommon (0.5-13%). Unlike other causes of obstructive jaundice, the role of endoscopic intervention in obstructive jaundice complicated by HCC has not been clearly defined. The aim of this study was to evaluate the clinical characteristics of obstructive jaundice caused by HCC and predictive factors for successful endoscopic intervention.
MATERIALS AND METHODS
From 1999 to 2009, 54 patients with HCC who underwent endoscopic intervention to relieve obstructive jaundice were included. We defined endoscopic intervention as a clinical success when the obstructive jaundice was relieved within 4 weeks.
RESULTS
Clinical success was achieved in 23 patients (42.6%). Patients in the clinical success group showed better Child-Pugh liver function (C-P grade A or B/C; 17/6 vs. 8/20), lower total bilirubin levels (8.1+/-5.3 mg/dL vs. 23.1+/-10.4 mg/dL) prior to the treatment, and no history of alcohol consumption. The only factor predictive of clinical success by multivariate analysis was low total bilirubin level at the time of endoscopic intervention, regardless of history of alcohol consumption [odds ratio 1.223 (95% confidence interval, 1.071-1.396), p=0.003]. The cut-off value of pre-endoscopic treatment total bilirubin level was 12.8 mg/dL for predicting the clinical prognosis. Median survival after endoscopic intervention in the clinical success group was notably longer than that in the clinical failure group (5.6 months vs. 1.5 months, p< or =0.001).
CONCLUSION
Before endoscopic intervention, liver function, especially total bilirubin level, should be checked to achieve the best clinical outcome. Endoscopic intervention can be helpful to relieve jaundice in well selected patients with HCC.

Keyword

Hepatocellular carcinoma; obstructive jaundice; endoscopic retrograde cholangiopancreatography; palliative treatment

MeSH Terms

Adult
Aged
Bilirubin/blood
Carcinoma, Hepatocellular/*complications
Cholangiopancreatography, Endoscopic Retrograde/adverse effects
Female
Humans
Jaundice, Obstructive/complications/*surgery
Liver Function Tests
Liver Neoplasms/*complications
Logistic Models
Male
Middle Aged
Multivariate Analysis
Palliative Care
Treatment Outcome
Bilirubin

Figure

• 

  Fig. 1 (A) Levels of serum total bilirubin in the clinical success group before and after endoscopic retrograde cholangiopancreatography (ERCP). (B) Levels of serum total bilirubin in the clinical failure group before and after ERCP.

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