A Retrospective Study of Biliary Drainage Strategies for Patients with Malignant Hilar Biliary Strictures

Abstract

Purpose

The main aim of this study was to compare the efficacy and safety of different biliary drainage strategies, including percutaneous transhepatic biliary drainage (PTBD) versus endoscopic biliary stenting (EBS) and unilateral versus bilateral stenting, in patients with unresectable malignant hilar biliary strictures (MHBSs).

Patients and Methods

This was a retrospective review of patients with inoperable MHBSs who underwent biliary drainage by either EBS or PTBD. Efficacy and safety were compared between the two pathways and between unilateral and bilateral stenting in the EBS group. The survival duration was analyzed with K-M curves and Log rank tests.

Results

From January 2015 to December 2019, a total of 206 (126: EBS and 80: PTBD) patients with MHBSs were enrolled in our study and underwent 270 procedures (173: EBS and 97: PTBD). Bilateral stenting was superior to unilateral stenting in terms of clinical success (69.6% vs 50.6%, p=0.039), especially for patients with Bismuth type IV (70.0% vs 30.3%, p=0.002). A higher decrease in bilirubin was seen with PTBD in patients with Bismuth types III–IV (66.9 vs 36.7, p=0.006). A survival advantage was seen in successful drainage (227 days vs 82 days, p<0.001), lower tumor-node-metastasis (TNM) scores (I–II) (195 days vs 139 days, p=0.012), and cholangiocarcinoma (184 days vs 84 days, p=0.001).

Conclusion

For patients with advanced MHBSs, bilateral stenting may achieve a better drainage effect than unilateral stenting, and PTBD may have a better performance in relieving cholestasis than EBS. Successful drainage and cholangiocarcinoma may provide greater long-term survival benefits.

Keywords:

• inoperable hilar malignancy
• endoscopic biliary stenting
• percutaneous transhepatic biliary drainage
• survival

Acknowledgments

The funding source had no involvement in the design, analysis, or writing of this paper or in the decision to publish this work. Special thanks are expressed to the medical staff of the Gastroenterology Division, Medical School of Chinese PLA, Beijing, China.

Abbreviations

MHBSs, malignant hilar biliary strictures; EBS, endoscopic biliary stenting; PTBD, percutaneous transhepatic biliary drainage; TNM, tumor-node-metastasis; CT, computed tomography; MRI, magnetic resonance imaging; MRCP, magnetic resonance cholangiopancreatography; SBS, side-by-side; SIS, side-in-side; TS, technical success; CS, clinical success.

Disclosure

The authors report no conflicts of interest related to this work.