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Endoscopic versus percutaneous intervention for palliation in malignant hilar bile duct obstruction – A comparative cohort study

  • Jeanne Lubbe
    Correspondence
    Correspondence: Department of Surgical Sciences, University of Stellenbosch, PO Box 1714, Belville, 7535, South Africa.
    Affiliations
    University of Stellenbosch, Department of Surgical Sciences, Division of Surgery, Tygerberg Hospital, Parow, South Africa

    Department of Clinical Sciences, Intervention and Technology (CLINTEC), Centre for Digestive Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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  • Jessica Lindemann
    Affiliations
    Department of Surgery, University of Cape Town Faculty of Health Sciences, Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa

    Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
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  • Washington Gondo
    Affiliations
    University of Stellenbosch, Department of Surgical Sciences, Division of Surgery, Tygerberg Hospital, Parow, South Africa
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  • Nina Kolev
    Affiliations
    Department of Surgery, University of Cape Town Faculty of Health Sciences, Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa
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  • Peter Aclavio
    Affiliations
    Department of Surgery, University of Cape Town Faculty of Health Sciences, Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa
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  • Stefan Hofmeyr
    Affiliations
    University of Stellenbosch, Department of Surgical Sciences, Division of Surgery, Tygerberg Hospital, Parow, South Africa
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  • Eduard Jonas
    Affiliations
    Department of Clinical Sciences, Intervention and Technology (CLINTEC), Centre for Digestive Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

    Department of Surgery, University of Cape Town Faculty of Health Sciences, Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa
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Published:September 16, 2022DOI:https://doi.org/10.1016/j.hpb.2022.09.005

      Abstract

      Background

      Biliary drainage in patients managed palliatively for malignant hilar obstruction can be achieved by endoscopic transpapillary stenting using endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic stent or catheter placement using percutaneous transhepatic cholangiography (PTC). This study compares ERC and PTC drainage for malignant hilar bile duct obstruction.

      Methods

      A retrospective study of drainage procedures at two academic hospitals was conducted from 2015 to 2020. Procedural success (divided into access-, bridging-, and technical success), therapeutic success, duration of therapeutic success and complications were analysed for different Bismuth-Corlette stricture types.

      Results

      A total of 293 patients were included, 153 (52.2%) in the ERC group and 140 (47.8%) in the PTC group. Access and bridging success in the ERC and PTC groups were 83.5% vs. 97.2% (p < 0.001) and 90.2% vs. 84.5% (p = 0.119), respectively. Technical and therapeutic success were equivalent between the two groups (98.3% vs. 99.3%, p = 0.854 and 81.7% vs. 73.3%, p = 0.242). Duration of therapeutic success was longer after ERC drainage compared to PTC drainage (p = 0.009) with a 3-month gain in duration of therapeutic success after ERC drainage (p = 0.006, 95% CI [26–160]). Cholangitis rates were equivalent (21.4% vs. 24.7%, p = 0.530), pancreatitis was more common in the ERC group (9.4% vs. 0%, p < 0.001) and procedure-related deaths more common in the PTC group (6.0% vs. 15.8%, p < 0.001).

      Conclusion

      Although ERC and PTC drainage of malignant hilar obstruction were similar regarding technical and therapeutic success, ERC drainage was more durable. Outcome differences for B–C stricture types should be explored in future studies.
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