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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 - Gut Liver (2015)

Bottom Line: 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).EBD was associated with a higher risk of procedure-related complications than PTBD.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.

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.

No MeSH data available.


Related in: MedlinePlus

Two representative cases of preoperative biliary drainage for perihilar cholangiocarcinoma. Cholangiogram obtained using a 7-F endoscopic nasobiliary drainage tube that was advanced through the malignant stricture into the left intrahepatic duct of the future remnant liver (A). Fluoroscopic image showing the placement of the 8.5-F percutaneous transhepatic biliary drainage tube, which was deployed into the right intrahepatic duct (B).
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f1-gnl-09-791: Two representative cases of preoperative biliary drainage for perihilar cholangiocarcinoma. Cholangiogram obtained using a 7-F endoscopic nasobiliary drainage tube that was advanced through the malignant stricture into the left intrahepatic duct of the future remnant liver (A). Fluoroscopic image showing the placement of the 8.5-F percutaneous transhepatic biliary drainage tube, which was deployed into the right intrahepatic duct (B).

Mentions: Representative cases that underwent PTBD and EBD procedures are shown in Fig. 1. PTBD was always performed on patients under local anesthesia with application of meperidine (25 to 50 mg) by several interventional radiologists with more than 10 years of experience. After draping the operation field, biliary duct was punctured using a 21-gauge Chiba needle through a right or left intercostal percutaneous approach under ultrasound and fluoroscopic guidance. After puncturing the target duct and confirming bile juice flow from the Chiba needle, cholangiography was performed to localize the site of obstruction by injecting contrast material gently, under fluoroscopic guidance. Then, an 8.5-F drainage catheter with multiple side holes (Cook Medical Inc., Bloomington, IN, USA) was placed and was not exchanged before surgery. EBD was performed using a duo-denoscope with a 4.2-mm operative channel (TFJ 240 or TJF 260; Olympus, Tokyo, Japan) by three experienced endoscopists (K.H.L., K.T.L., and J.K.L.). All patients were sedated using mid-azolam (2 to 5 mg) with meperidine (25 to 50 mg) administered intravenously and appropriate cardiopulmonary monitoring. A small endoscopic sphinctertomy was performed in all patients to facilitate introduction of the various catheters and prevent pancreatitis. After successful biliary cannulation, a guidewire was inserted into the future remnant lobe and then a selective cholangiogram was taken to localize the site of obstruction. Distal end of the ERBD (7 or 8.5 F) or ENBD (5 or 7 F) catheter was advanced through the guidewire into the left or right-side hepatic duct and upward to the biliary stricture, preferentially to the future remnant lobe.


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 - Gut Liver (2015)

Two representative cases of preoperative biliary drainage for perihilar cholangiocarcinoma. Cholangiogram obtained using a 7-F endoscopic nasobiliary drainage tube that was advanced through the malignant stricture into the left intrahepatic duct of the future remnant liver (A). Fluoroscopic image showing the placement of the 8.5-F percutaneous transhepatic biliary drainage tube, which was deployed into the right intrahepatic duct (B).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4625710&req=5

f1-gnl-09-791: Two representative cases of preoperative biliary drainage for perihilar cholangiocarcinoma. Cholangiogram obtained using a 7-F endoscopic nasobiliary drainage tube that was advanced through the malignant stricture into the left intrahepatic duct of the future remnant liver (A). Fluoroscopic image showing the placement of the 8.5-F percutaneous transhepatic biliary drainage tube, which was deployed into the right intrahepatic duct (B).
Mentions: Representative cases that underwent PTBD and EBD procedures are shown in Fig. 1. PTBD was always performed on patients under local anesthesia with application of meperidine (25 to 50 mg) by several interventional radiologists with more than 10 years of experience. After draping the operation field, biliary duct was punctured using a 21-gauge Chiba needle through a right or left intercostal percutaneous approach under ultrasound and fluoroscopic guidance. After puncturing the target duct and confirming bile juice flow from the Chiba needle, cholangiography was performed to localize the site of obstruction by injecting contrast material gently, under fluoroscopic guidance. Then, an 8.5-F drainage catheter with multiple side holes (Cook Medical Inc., Bloomington, IN, USA) was placed and was not exchanged before surgery. EBD was performed using a duo-denoscope with a 4.2-mm operative channel (TFJ 240 or TJF 260; Olympus, Tokyo, Japan) by three experienced endoscopists (K.H.L., K.T.L., and J.K.L.). All patients were sedated using mid-azolam (2 to 5 mg) with meperidine (25 to 50 mg) administered intravenously and appropriate cardiopulmonary monitoring. A small endoscopic sphinctertomy was performed in all patients to facilitate introduction of the various catheters and prevent pancreatitis. After successful biliary cannulation, a guidewire was inserted into the future remnant lobe and then a selective cholangiogram was taken to localize the site of obstruction. Distal end of the ERBD (7 or 8.5 F) or ENBD (5 or 7 F) catheter was advanced through the guidewire into the left or right-side hepatic duct and upward to the biliary stricture, preferentially to the future remnant lobe.

Bottom Line: 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).EBD was associated with a higher risk of procedure-related complications than PTBD.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.

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.

No MeSH data available.


Related in: MedlinePlus