Preoperative Biliary Drainage for Periampullary Cancer: A comparison between endoscopic drainage and percutaneous transhepatic drainage

Hwang, Dae Wook; Kim, Sun Whe; Yoon, Yoo Seok; Kim, Ji Hoon; Jang, Jin Young; Park, Yong Hyun

Abstract

PURPOSE
A preoperative biliary drainage procedure (endoscopic nasogastric biliary drainage, ENBD; endoscopic retrograde biliary drainage, ERBD; or percutaneous transhepatic biliary drainage, PTBD) is infrequently performed in periampullary cancer patients with obstructive jaundice. Among these different biliary drainage procedures, a safer and more informative procedure should be performed in the indicated cases. However, no comparative study has been done between the two biliary drainage methods (endoscopic vs. percutaneous). The aim of this study is to compare the clinical outcome of these two biliary drainage methods in periampullary cancer and to suggest guidelines for selecting the appropriate preoperative biliary drainage procedure. METHODS: Between January 1996 and June 2002, 25 patients underwent pancreaticoduodenectomy (Whipples' operation or pylorus preserving pancreaticoduodenectomy) after ENBD/ERBD (Group A) due to periampullary cancer. Twenty- five patients who ubderwent PTBD preoperatively were matched with Group A, according to age group, sex, diagnosis, and type of operation during the same period (Group B). RESULTS: There were no differences in operative time, intraoperative/postoperative transfusion, total/postoperative length of hospital stay, incidence of postoperative complication, TNM staging, or perineural/endovascular/endolymphatic invasion. However, the thickness of CBD wall (Group A: Group B=1.78+/-0.55 mm : 1.14+/-0.37 mm, P<0.001) and degree of inflammation of the CBD wall (Group A> Group B, P<0.001) were significantly different between the two groups. CONCLUSION: Although a significant difference of clinical outcome between the two preoperative biliary drainage methods could not be identified in this study, the inflammation of operative field resulting from ENBD/ERBD is expected to cause surgical difficulties and ultimately affect postoperative complications.