Clin Endosc.  2015 Jan;48(1):8-14. 10.5946/ce.2015.48.1.8.

Preoperative Drainage for Malignant Biliary Strictures: Is It Time for Self-Expanding Metallic Stents?

• Roque J
• Ho SH
• Goh KL

• KMID: 2221752
• DOI: http://doi.org/10.5946/ce.2015.48.1.8

Abstract

Palliation of jaundice improves the general health of the patient and, therefore, surgical outcomes. Because of the complexity and location of strictures, especially proximally, drainage has been accompanied by increased morbidity due to sepsis. Another concern is the provocation of an inflammatory and fibrotic reaction around the area of stent placement. Preoperative biliary drainage with self-expanding metallic stent (SEMS) insertion can be achieved via a percutaneous method or through endoscopic retrograde cholangiopancreatography. A recently published multicenter randomized Dutch study has shown increased morbidity with preoperative biliary drainage. A Cochrane meta-analysis has also shown a significantly increased complication rate with preoperative drainage. However, few of these studies have used a SEMS, which allows better biliary drainage. No randomized controlled trials have compared preoperative deployment of SEMS versus conventional plastic stents. The outcomes of biliary drainage also depend on the location of the obstruction, namely the difficulty with proximal compared to distal strictures. Pathophysiologically, palliation of jaundice will benefit all patients awaiting surgery. However, preoperative drainage often results in increased morbidity because of procedure-related sepsis. The use of SEMS may change the outcome of preoperative biliary drainage dramatically.

Keyword

Malignant biliary stricture; Preoperative biliary drainage; Percutaneous transhepatic biliary drainage; Self-expanding metallic stents; Surgical bypass

MeSH Terms

Cholangiopancreatography, Endoscopic Retrograde
Constriction, Pathologic*
Drainage*
Humans
Jaundice
Plastics
Sepsis
Stents*
Plastics

Reference

1. Lee JH. Self-expandable metal stents for malignant distal biliary strictures. Gastrointest Endosc Clin N Am. 2011; 21:463–480. PMID: 21684465.

2. Fang Y, Gurusamy KS, Wang Q, et al. Pre-operative biliary drainage for obstructive jaundice. Cochrane Database Syst Rev. 2012; 9:CD005444. PMID: 22972086.

3. Hatfield AR, Tobias R, Terblanche J, et al. Preoperative external biliary drainage in obstructive jaundice. A prospective controlled clinical trial. Lancet. 1982; 2:896–899. PMID: 6126752.

4. Jaganmohan S, Lee JH. Self-expandable metal stents in malignant biliary obstruction. Expert Rev Gastroenterol Hepatol. 2012; 6:105–114. PMID: 22149586.

5. Hong SK, Jang JY, Kang MJ, Han IW, Kim SW. Comparison of clinical outcome and cost-effectiveness after various preoperative biliary drainage methods in periampullary cancer with obstructive jaundice. J Korean Med Sci. 2012; 27:356–362. PMID: 22468097.

6. Kloek JJ, van der Gaag NA, Aziz Y, et al. Endoscopic and percutaneous preoperative biliary drainage in patients with suspected hilar cholangiocarcinoma. J Gastrointest Surg. 2010; 14:119–125. PMID: 19756881.

7. Takahashi Y, Nagino M, Nishio H, Ebata T, Igami T, Nimura Y. Percutaneous transhepatic biliary drainage catheter tract recurrence in cholangiocarcinoma. Br J Surg. 2010; 97:1860–1866. PMID: 20799295.

8. Speer AG, Cotton PB, Russell RC, et al. Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice. Lancet. 1987; 2:57–62. PMID: 2439854.

9. Smith AC, Dowsett JF, Russell RC, Hatfield AR, Cotton PB. Randomised trial of endoscopic stenting versus surgical bypass in malignant low bileduct obstruction. Lancet. 1994; 344:1655–1660. PMID: 7996958.

10. Moss AC, Morris E, Leyden J, MacMathuna P. Malignant distal biliary obstruction: a systematic review and meta-analysis of endoscopic and surgical bypass results. Cancer Treat Rev. 2007; 33:213–221. PMID: 17157990.

11. Davids PH, Groen AK, Rauws EA, Tytgat GN, Huibregtse K. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet. 1992; 340:1488–1492. PMID: 1281903.

12. Kaassis M, Boyer J, Dumas R, et al. Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. Gastrointest Endosc. 2003; 57:178–182. PMID: 12556780.

13. Soderlund C, Linder S. Covered metal versus plastic stents for malignant common bile duct stenosis: a prospective, randomized, controlled trial. Gastrointest Endosc. 2006; 63:986–995. PMID: 16733114.

14. Yeoh KG, Zimmerman MJ, Cunningham JT, Cotton PB. Comparative costs of metal versus plastic biliary stent strategies for malignant obstructive jaundice by decision analysis. Gastrointest Endosc. 1999; 49(4 Pt 1):466–471. PMID: 10202060.

15. Ayaru L, Kurzawinski TR, Shankar A, Webster GJ, Hatfield AR, Pereira SP. Complications and diagnostic difficulties arising from biliary self-expanding metal stent insertion before definitive histological diagnosis. J Gastroenterol Hepatol. 2008; 23:315–320. PMID: 18289360.

16. Lytras D, Olde Damink SW, Amin Z, Imber CJ, Malagó M. Radical surgery in the presence of biliary metallic stents: revising the palliative scenario. J Gastrointest Surg. 2011; 15:489–495. PMID: 21246414.

17. McPherson GA, Benjamin IS, Hodgson HJ, Bowley NB, Allison DJ, Blumgart LH. Pre-operative percutaneous transhepatic biliary drainage: the results of a controlled trial. Br J Surg. 1984; 71:371–375. PMID: 6372935.

18. van der Gaag NA, Rauws EA, van Eijck CH, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med. 2010; 362:129–137. PMID: 20071702.

19. Martignoni ME, Wagner M, Krähenbühl L, Redaelli CA, Friess H, Büchler MW. Effect of preoperative biliary drainage on surgical outcome after pancreatoduodenectomy. Am J Surg. 2001; 181:52–59. PMID: 11248177.

20. Coss A, Byrne MF. Preoperative biliary drainage in malignant obstruction: indications, techniques, and the debate over risk. Curr Gastroenterol Rep. 2009; 11:145–149. PMID: 19281702.

21. Belghiti J, Ogata S. Preoperative optimization of the liver for resection in patients with hilar cholangiocarcinoma. HPB (Oxford). 2005; 7:252–253. PMID: 18333201.

22. Farges O, Regimbeau JM, Fuks D, et al. Multicentre European study of preoperative biliary drainage for hilar cholangiocarcinoma. Br J Surg. 2013; 100:274–283. PMID: 23124720.

23. Nakayama T, Ikeda A, Okuda K. Percutaneous transhepatic drainage of the biliary tract: technique and results in 104 cases. Gastroenterology. 1978; 74:554–559. PMID: 415929.

24. Whipple AO, Parsons WB, Mullins CR. Treatment of carcinoma of the ampulla of vater. Ann Surg. 1935; 102:763–779. PMID: 17856666.

25. Decker C, Christein JD, Phadnis MA, Wilcox CM, Varadarajulu S. Biliary metal stents are superior to plastic stents for preoperative biliary decompression in pancreatic cancer. Surg Endosc. 2011; 25:2364–2367. PMID: 21373939.

26. Grunhagen DJ, Dunne DF, Sturgess RP, et al. Metal stents: a bridge to surgery in hilar cholangiocarcinoma. HPB (Oxford). 2013; 15:372–378. PMID: 23458664.

27. Isayama H, Komatsu Y, Tsujino T, et al. A prospective randomised study of "covered" versus "uncovered" diamond stents for the management of distal malignant biliary obstruction. Gut. 2004; 53:729–734. PMID: 15082593.

28. Siddiqui AA, Mehendiratta V, Loren D, et al. Self-expanding metal stents (SEMS) for preoperative biliary decompression in patients with resectable and borderline-resectable pancreatic cancer: outcomes in 241 patients. Dig Dis Sci. 2013; 58:1744–1750. PMID: 23179157.

29. Singal AK, Ross WA, Guturu P, et al. Self-expanding metal stents for biliary drainage in patients with resectable pancreatic cancer: single-center experience with 79 cases. Dig Dis Sci. 2011; 56:3678–3684. PMID: 21750930.

30. Paik WH, Park YS, Hwang JH, et al. Palliative treatment with self-expandable metallic stents in patients with advanced type III or IV hilar cholangiocarcinoma: a percutaneous versus endoscopic approach. Gastrointest Endosc. 2009; 69:55–62. PMID: 18657806.