Gut Liver.  2015 Nov;9(6):791-799. 10.5009/gnl14243.

A Comparison of Preoperative Biliary Drainage Methods for Perihilar Cholangiocarcinoma: Endoscopic versus Percutaneous Transhepatic Biliary Drainage

• Kim KM
• Park JW
• Lee JK
• Lee KH
• Lee KT
• Shim SG

• KMID: 2377938
• DOI: http://doi.org/10.5009/gnl14243

Abstract

BACKGROUND/AIMS
Controversy remains over the optimal approach to preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma. We compared the clinical outcomes of endoscopic biliary drainage (EBD) with those of percutaneous transhepatic biliary drainage (PTBD) in patients undergoing preoperative biliary drainage for perihilar cholangiocarcinoma.
METHODS
A total of 106 consecutive patients who underwent biliary drainage before surgical treatment were divided into two groups: the PTBD group (n=62) and the EBD group (n=44).
RESULTS
Successful drainage on the first attempt was achieved in 36 of 62 patients (58.1%) with PTBD, and in 25 of 44 patients (56.8%) with EBD. There were no significant differences in predrainage patient demographics and decompression periods between the two groups. Procedure-related complications, especially cholangitis and pancreatitis, were significantly more frequent in the EBD group than the PTBD group (PTBD vs EBD: 22.6% vs 54.5%, p<0.001). Two patients (3.8%) in the PTBD group experienced catheter tract implantation metastasis after curative resection during the follow-up period.
CONCLUSIONS
EBD was associated with a higher risk of procedure-related complications than PTBD. These complications were managed properly without severe morbidity; however, in the PTBD group, there were two cases of cancer dissemination along the catheter tract.

Keyword

Complications; Endoscopic biliary drainage; Perihilar cholangiocarcinoma; Percutaneous transhepatic biliary drainage; Preoperative biliary drainage

MeSH Terms

Aged
Aged, 80 and over
Bile Duct Neoplasms/*surgery
Bile Ducts/surgery
Cholangitis/etiology
Drainage/adverse effects/*methods
Endoscopy, Gastrointestinal/adverse effects/*methods
Female
Humans
Klatskin Tumor/*surgery
Liver/surgery
Male
Middle Aged
Pancreatitis/etiology
Postoperative Complications/etiology
Preoperative Care/adverse effects/*methods
Treatment Outcome