Three non-operative procedures for biliary drainage in malignant hilar biliary obstruction

Abstract

Objective To evaulate the efficacy and complication of different non-operative procedures in malignant hilar biliary obstruction （MHBO）. Methods The data of 245 patients with MHBO, including 31 cases of Bismuth type Ⅰ , 24 of type Ⅱ , 108 cases of type Ⅲ and 74 of type Ⅳ, were retrospectively analyzed. The patients were assigned into 3 groups according to therapy, including 86 patients in endoscopy group, 104 in percutaneous biliary drainage （PTBD） group and 55 in combination group （endoscopic drainage plus PTBD）. Results Jaundice resolution rates in endosccopy group, PTBD group and combination group were 82.4% （56/68, 18 patients underwent additional PTBD because of cholangitis in latter time）, 72. 1% （75/104） and 89. 1% （49/55）, respectively. For patients of Bismuth type Ⅲ, jaundice resolution rates were 78.6% （22/28, 7 patients underwent PTBD because of cholangitis in latter time） , 69. 8% （ 30/43 ） and 90% （ 27/30 ）, respectively. Moreover, jaundice resolution rate was significantly higher in bilateral drainage （89. 5% ） than that in unilateral drainage （73%） （P 〈0. 05）. Cholangitis was complicated in 19 cases from endoscopy group （22. 1%, 19/86） , which were significantly higher than that in PTBD group （5. 8%, 6/104） and combination group （5. 5%, 3/55） （ P 〈0. 05）. For patients of Bisninth type Ⅲ and above, the occurrence rate of post-procedure cholangitis in endoscopy group （ 33.3%, 18/54） was significantly higher than those of the other two groups （6. 6%, 5/76 and 5.8%, 3/52） （P 〈 0. 05）. Conclusion For patients with unresectable MHBO, endoscopic and/or percutaneous biliary drainage are both effective for jaundice resolution, but cholangitis is complicated more often after endoscopic intervention. For those with type Ⅲ and above, combination of endoscopic and percutaneous biliary drainage can relieve jaundice with lower incidence of post-procedure cholangitis. Key words: Endoscopy ; Cholangitis ; Drainage ; MHBO