Abstract
BackgroundEndoscopic biliary stenting (EBS) is one of the most important palliative treatments for biliary tract cancer. However, reflux cholangitis arising from bacterial adherence to the inner wall of the stent must be avoided. We evaluated the use of EBS above the sphincter of Oddi to determine whether reflux cholangitis could be prevented in preoperative cases.MethodsFifty-seven patients with primary biliary tract cancer were retrospectively recruited for the evaluation of stent placement either above (n = 25; inside stent group) or across (n = 32; conventional stent group) the sphincter of Oddi. We compared the stent patency periods prior to the time of surgical resection.ResultsThe preoperative periods were 96.3 days in the conventional stent group and 96.8 days in the inside stent group (P = 0.979). Obstructive jaundice and/or acute cholangitis occurred in 7 patients (28.0%) in the inside stent group and in 15 patients (46.9%) in the conventional stent group during the preoperative period (P = 0.150). The average patency periods of the stents were 85.2 days (range, 13–387 days) for the inside stent group and 49.1 days (range, 9–136 days) for the conventional stent group (log-rank test: P = 0.009). The mean numbers of re-interventions because of stent occlusion were 0.32 for the inside stent group and 1.03 for the conventional stent group (P = 0.026). Post-endoscopic retrograde cholangiopancreatography complications occurred in 2 patients in the inside stent group and 4 patients in the conventional stent group (P = 0.516). Postoperative liver abscess occurred in 1 patient in the inside stent group and 5 patients in the conventional stent group (P = 0.968). Inside stent placement was the only significant preventative factor associated with stent obstruction based on univariate (hazard ratio [HR], 0.286; 95% confidence interval [CI], 0.114-0.719; P = 0.008) and multivariate (HR, 0.292; 95% CI, 0.114-0.750; P = 0.011) analyses.ConclusionTemporary plastic stent placement above the sphincter of Oddi is a better bridging treatment than conventional stent placement in preoperative primary biliary tract cancer.
Highlights
Endoscopic biliary stenting (EBS) is one of the most important palliative treatments for biliary tract cancer
Many Japanese studies report that postoperative mortality rates following major liver resection performed for hilar bile duct cancer are low, a finding that leads many to believe that preoperative biliary drainage an essential element in preoperative treatment [6,7]
Safe surgical resections cannot be performed in patients with reflux cholangitis, which is a life-threatening complication
Summary
Endoscopic biliary stenting (EBS) is one of the most important palliative treatments for biliary tract cancer. Preventing reflux cholangitis by performing endoscopic treatment is a challenge for the preoperative management of patients with biliary tract cancer. Some reports have stated that an inside stent is very useful for preventing reflux cholangitis following liver transplantation [8,9]. Biliary tract infection is the most severe adverse event experienced by patients undergoing systemic chemotherapy for biliary tract cancer This risk must be prevented to allow the safe continuation of systemic chemotherapy and/or radiotherapy. If an inside stent could be used to prolong the patency period, chemotherapy and/or radiotherapy could be safely performed prior to surgical resection. We retrospectively compared the use of conventional plastic stents and inside stents in patients with primary biliary tract cancer
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