Abstract
AimIn this study, we assessed the factors contributing to ineffective drainage in the initial transpapillary uncovered self-expandable metal stent (USEMS) placements in patients with unresectable malignant hilar biliary strictures (UMHBSs) (Bismuth type II or higher).MethodsThis was a retrospective, single-center study. A total of 97 patients with UMHBSs who underwent technically successful initial USEMS placements using endoscopic retrograde cholangiopancreatography (ERCP) were classified into the effective drainage group (n = 73) or the ineffective drainage group (n = 24). We then compared group characteristics, clinical outcomes, and drained liver volumes. Drained liver volume was measured by using computed tomography volumetry. The definition of effective biliary drainage was a 50% decrease in the serum total bilirubin level or normalization of the level within 14 days of stent placement.ResultsUnivariate analysis showed that ineffective drainage was associated with the pre-ERCP serum total bilirubin level (P = 0.0075), pre-ERCP serum albumin level (P = 0.042), comorbid liver cirrhosis (P = 0.010), drained liver volume (P = 0.0010), and single stenting (P = 0.022). Multivariate analysis identified comorbid liver cirrhosis (adjusted odds ratio [OR], 5.79; 95% confidence interval [CI], 1.30–25.85; P = 0.022) and drained liver volume < 50% (adjusted OR, 5.50; 95% CI, 1.50–20.25; P = 0.010) as independent risk factors of ineffective drainage.ConclusionComorbid liver cirrhosis and a drained liver volume < 50% contributed significantly to ineffective drainage in the initial transpapillary USEMS placements for UMHBSs.
Highlights
A malignant hilar biliary stricture (MHBS) is caused by cholangiocarcinoma, gallbladder carcinoma, metastatic liver tumors, or hilar lymph node metastases from various cancers
Univariate analysis showed that ineffective drainage was associated with the pre-endoscopic retrograde cholangiopancreatography (ERCP) serum total bilirubin level (P = 0.0075), pre-ERCP serum albumin level (P = 0.042), comorbid liver cirrhosis (P = 0.010), drained liver volume (P = 0.0010), and single stenting (P = 0.022)
Multivariate analysis identified comorbid liver cirrhosis and drained liver volume < 50% as independent risk factors of ineffective drainage
Summary
A malignant hilar biliary stricture (MHBS) is caused by cholangiocarcinoma, gallbladder carcinoma, metastatic liver tumors, or hilar lymph node metastases from various cancers. Obstructive jaundice affects the biliary tree, and the hepatic cell and liver functions. Plastic and metallic stents (MSs) are available for biliary drainage in patients with unresectable MHBSs (UMHBSs), and studies have shown that MSs are superior in terms of their patency period and cost effectiveness [2, 3]. The factors contributing to ineffective drainage in the initial transpapillary USEMS placements in patients with UMHBSs are unclear. In the TOKYO Criteria 2014, functional success, which indicates effective biliary drainage, was defined as a 50% decrease in the serum total bilirubin level or normalization of the serum total bilirubin level within 14 days of stent placement [5]. This study assessed factors contributing to ineffective drainage in the initial transpapillary USEMS placements in patients with UMHBSs (Bismuth type II or higher)
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