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

Figures & data

Table 1 The Baseline Characteristics Between EBS and PTBD in Patients with Bismuth Types III–IV

Characteristic	EBS (n=97)	PTBD (n=48)	P value
Age (years)	62	58	0.099
Gender (n, %)			0.509
Male (n, %)	53 (54.6%)	29 (60.4%)
Female (n, %)	44 (45.4%)	19 (39.6%)
ECOG performance status (n, %)			0.857
2	51 (52.6%)	26 (54.2%)
3–4	46 (47.4%)	22 (45.8%)
TNM (n, %)			0.867
I–II	27 (27.8%)	14 (29.2%)
III–IV	70 (72.2%)	34 (70.8%)
Bismuth (n, %)			0.677
III	31 (32.0%)	17 (35.4%)
IV	66 (68.0%)	31 (64.6%)
TBIL (µmol/L)	181.75	227.80	0.078
AST (U/L)	81.90	83.65	0.979
ALT (U/L)	68.30	88.15	0.329
CA199 (U/mL)	348.10	607.95	0.275
CEA (µg/L)	3.67	4.26	0.782

Table 2 Efficacy and Safety Comparison Between EBS and PTBD in Patients with Bismuth Types III–IV

	EBS (n=97)	PTBD (n=48)	p
*Clinical success (%, ratio)	52.6% (50/95)	67.4% (31/46)	0.097
TBIL decrease (µmol/L)	36.70	66.90	0.006
Complication (%, ratio)	39.2%(38/97)	39.6% (19/48)	0.962
Cholangitis (%, ratio)	27.8% (27/97)	29.2% (14/48)	0.867
Hemorrhage (%, ratio)	3.1% (3/97)	2.1% (1/48)	1.000

Notes: *Postprocedure TBIL was missing in 2 cases in each group.

Table 3 Comparison of the Baseline Characteristics Between Patients Who Underwent Bilateral and Unilateral Stenting

Characteristic	Unilateral (n=80)	Bilateral (n=47)	P value
Age (years)	62	65	0.199
Gender (n, %)			0.606
Male	48 (60.0%)	26 (55.3%)
Female	32 (40.0%)	21 (44.7%)
ECOG performance status (n, %)			0.629
2	39 (48.8%)	25 (53.2%)
3–4	41 (51.2%)	22 (46.8%)
TNM (n, %)			0.636
I-II	24 (30.0%)	16 (34.0%)
III–IV	56 (70.0%)	31 (66.0%)
Bismuth (n, %)			0.178
II	24 (30.0%)	9 (19.1%)
III–IV	56 (70.0%)	38 (80.9%)
TBIL (µmol/L)	157.90	196.10	0.057
AST (U/L)	67.50	120.50	0.003
ALT (U/L)	63.80	96.70	0.020
CA199 (U/mL)	356.00	350.00	0.912
CEA (µg/L)	4.48	4.02	0.913
Stent types (n, %)			1.000
Metal	8 (10.0%)	4 (8.5%)
Plastic	72 (90.0%)	43 (91.5%)

Table 4 Efficacy and Safety Comparison Between Unilateral and Bilateral Stenting

	Unilateral (n=80)	Bilateral (n=47)	p value
*Clinical success (%, ratio)	50.6%(40/79)	69.6%(32/46)	0.039
TBIL decrease (µmol/L)	18.90	87.50	0.001
Complication (%, ratio)	36.3%(29/80)	40.4%(19/47)	0.639
Cholangitis (%, ratio)	21.3%(17/80)	31.9%(15/47)	0.181
Pancreatitis (%, ratio)	12.5%(10/80)	10.6%(5/47)	0.754
Hemorrhage (%, ratio)	5.0%(4/80)	4.3%(2/47)	0.849

Note: *Postprocedure TBIL was missing in 1 case in each group.

Table 5 The Clinical Success Rates in Unilateral and Bilateral Groups with Bismuth II-IV Scores

%(n)	Unilateral (n=79)	Bilateral (n=46)	p
Bismuth II	70.8%(17/24)	77.8%(7/9)	1.000
Bismuth III	59.1%(13/22)	57.1%(4/7)	1.000
Bismuth IV	30.3%(10/33)	70.0%(21/30)	0.002

Figure 1 Survival time curve obtained by Kaplan-Meier analysis shows no difference between EBS and PTBD (P = 0.057).

Figure 2 Survival time curve obtained by Kaplan-Meier analysis shows no difference between unilateral and bilateral drainage (P = 0.371).

Figure 3 Kaplan-Meier analysis of survival between patients with or without clinical success. Cumulative survival rates were significantly higher in patients with CS (green line) (P = 0.000).

Figure 4 Kaplan-Meier analysis of survival between patients with TNM I–II and those with TNM III–IV. Cumulative survival rates were significantly higher in patients with TNM I-II (blue line) (P = 0.012).

Figure 5 Kaplan-Meier analysis of survival between patients with cholangiocarcinoma and those with other tumors. Cumulative survival rates were significantly higher in patients with cholangiocarcinoma (green line) (P = 0.001).