Lower incidence of complications in endoscopic nasobiliary drainage for hilar cholangiocarcinoma

• 作者: Hiroaki Yamato Hiroshi Kawakami Kazumichi Kawakubo Kazunori Eto Kimitoshi Kubo Manabu Onodera Masaki Kuwatani Naoya Sakamoto Nobuyuki Ehira Shin Haba Shuhei Kawahata Taiki Kudo Yoko A Taya Yoshimasa Kubota
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: HILAR CHOLANGIOCARCINOMA ENDOSCOPIC nasobiliary drainage ENDOSCOPIC biliary STENTING ENDOSCOPIC SPHINCTEROTOMY COMPLICATIONS
• 年，卷（期）: 2016,（9）
• 页码范围: 385-390
• 页数: 6页
• 分类号: R

摘要

AIM: To identify the most effective endoscopic biliary drainage technique for patients with hilar cholangiocarcinoma.METHODS: In total, 118 patients with hilar cholangiocarcinoma underwent endoscopic management [endoscopic nasobiliary drainage (ENBD) or endoscopic biliary stenting] as a temporary drainage in our institution between 2009 and 2014. We retrospectively evaluated all complications from initial endoscopic drainage to surgery or palliative treatment. The risk factors for biliary reintervention, post-endoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis, and percutaneous transhepatic biliary drainage (PTBD) were also analyzed using patient- and procedure-related characteristics. The risk factors for bilateral drainage were examined in a subgroup analysis of patients who underwent initial unilateral drainage.RESULTS: In total, 137 complications were observed in 92 (78%) patients. Biliary reintervention was required in 83 (70%) patients. ENBD was significantly associated with a low risk of biliary reintervention [odds ratio (OR) = 0.26, 95%CI: 0.08-0.76, P = 0.012]. Post-ERCP pancreatitis was observed in 19 (16%) patients. An absence of endoscopic sphincterotomy was significantly associated with post-ERCP pancreatitis (OR = 3.46,95%CI: 1.19-10.87, P = 0.023). PTBD was required in 16 (14%) patients, and Bismuth type III or IV cholangiocarcinoma was a significant risk factor (OR =7.88, 95%CI: 1.33-155.0, P = 0.010). Of 102 patients with initial unilateral drainage, 49 (48%) required bilateral drainage. Endoscopic sphincterotomy (OR =3.24, 95%CI: 1.27-8.78, P = 0.004) and Bismuth II,III, or IV cholangiocarcinoma (OR = 34.69, 95%CI:4.88-736.7, P < 0.001) were significant risk factors for bilateral drainage.CONCLUSION: The endoscopic management of hilar cholangiocarcinoma is challenging. ENBD should be selected as a temporary drainage method because of its low risk of complications.