Endoscopic retrograde cholangiopancreatography and endoscopic decompression in the malignant obstruction of the extrahepatic biliary tracts – a retrospective analysis

Abstract

Background. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic biliary decompression are of the highest priority among minimally invasive procedures for the correction of the malignant obstruction of the extrahepatic biliary tracts. For this purpose, nasobiliary drainage and plastic or metal stents are used. However, it is not always possible to perform the endoscopic drainage of biliary ducts when there is a malignant obstruction. Purpose – to assess the immediate results of the use of the ERCP and endoscopic biliary decompression in malignant obstruction of the extrahepatic biliary tracts depending on the degree of obstruction. Materials and methods. A retrospective analysis of 106 cases of the malignant obstruction of the extrahepatic biliary tracts was performed. Out of 106 patients, 43 (40,6%) were males, and 63 (59,4%) were females. The age range of the patients was from 42 to 90 (68,4±11,1) years. Obstruction at the level of the major duodenal papilla was in 18 (17%) patients; at the level of the distal third of the common bile duct – in 66 (62,3%) patients; at the level of the middle third of the common bile duct – in 11 (10,4%) patients; at the level of the proximal third of the common bile duct – in 11 (10,4%) patients. Results. Out of 106 patients we managed to perform the ERCP in 94 (88,7%), and in 79 (84%) of them endoscopic drainage was successful. The complications after the ERCP were observed in 9 (8,5%) patients. In the malignant obstruction of the extrahepatic biliary tracts at the level of the major duodenal papilla we managed to perform the ERCP and restore the bile outflow in 17 out of 18 patients. In the malignant obstruction of the common bile duct, we managed to perform the ERCP in 77 (87,5%) out of 88 patients. In the obstruction at the level of the distal third, the endoscopic drainage was successful in 50 (87,7%) out of 57 patients who had undergone the ERCP. In the obstruction of the middle and proximal thirds of the common bile duct, the endoscopic drainage was successful in 12 (60%) out of 20 patients in which we managed to perform the ERCP. In the tumoral obstruction of the common bile duct, decompression at the level of the distal third was more successful (p = 0,027). Taking into consideration the obstruction of the major duodenal papilla, endoscopic biliary decompression was much more effective in the obstruction at the level of the major duodenal papilla and the distal third of the common bile duct compared to the obstruction of more proximal regions of the common bile duct (p = 0,002). In the tumoral obstruction of the extrahepatic biliary tracts at the level of the middle and proximal thirds of the common bile duct, the development of acute pancreatitis was characteristic of this process (p = 0,027). Conclusions. The performed retrospective analysis of the use of the ERCP in the malignant obstruction of the extrahepatic biliary tracts showed higher effectiveness of the endoscopic decompression in the obstruction of the distal regions of the extrahepatic biliary tracts compared with the obstruction at the level of the middle and proximal thirds of the common bile duct. Acute pancreatitis as a complication of the ERCP and endoscopic surgeries was significantly more often observed in the obstruction at the level of the middle and proximal thirds of the common bile duct.