Division of Surgical Oncology, Department of Surgery, University of Louisville, 550 S. Jackson Street, Louisville, KY, 40202, USA.
Department of Radiology, Norton Hospital, Louisville, KY, USA.
Surg Endosc. 2020 Mar;34(3):1186-1190. doi: 10.1007/s00464-019-06871-2. Epub 2019 May 28.
In patients with cholangiocarcinoma (CC), management of biliary obstruction commonly involves either up-front percutaneous transhepatic biliary drainage (PTBD) or initial endoscopic retrograde cholangiopancreatography (ERCP) with stent placement. The objective of the study was to compare the efficacy and of initial ERCP with stent placement with efficacy of initial PTBD in management of biliary obstruction in CC.
A single-center database of patients with unresectable CC treated between 2006 and 2017 was queried for patients with biliary obstruction who underwent either PTBD or ERCP. Groups were compared with respect to patient, tumor, procedure, and outcome variables.
Of 87 patients with unresectable CC and biliary obstruction, 69 (79%) underwent initial ERCP while 18 (21%) underwent initial PTBD. Groups did not differ significantly with respect to age, gender, or tumor location. Initial procedure success did not differ between the groups (94% ERCP vs 89% PTBD, p = 0.339). Total number of procedures did not differ significantly between the two groups (ERCP median = 2 vs. PTC median = 2.5, p = 0.83). 21% of patients required ERCP after PTBD compared to 25% of patients requiring PTBD after ERCP (p = 1.00). Procedure success rate (97% ERCP vs. 93% PTBD, p = 0.27) and rates of cholangitis (22% ERCP vs. 17% PTBD, p = 0.58) were similar between the groups. Number of hospitalizations since initial intervention did not differ significantly between the two groups (ERCP median = 1 vs. PTC median = 3.5, p = 0.052).
In patients with CC and biliary obstruction, initial ERCP with stent placement and initial PTBD both represent safe and effective methods of biliary decompression. Initial ERCP and stenting should be considered for relief of biliary obstruction in such patients in centers with advanced endoscopic capabilities.
在胆管癌（CC）患者中，胆道梗阻的管理通常涉及经皮经肝胆道引流（PTBD）或初始内镜逆行胰胆管造影（ERCP）联合支架置入。本研究的目的是比较初始 ERCP 联合支架置入与初始 PTBD 在 CC 胆道梗阻管理中的疗效。
检索了 2006 年至 2017 年间在一家中心治疗的不可切除 CC 患者的单中心数据库，以确定接受 PTBD 或 ERCP 的胆道梗阻患者。比较两组患者、肿瘤、手术和结果变量。
在 87 例不可切除 CC 合并胆道梗阻的患者中，69 例（79%）接受了初始 ERCP，18 例（21%）接受了初始 PTBD。两组患者在年龄、性别或肿瘤位置方面无显著差异。初始手术成功率在两组间无显著差异（94%ERCP 与 89%PTBD，p=0.339）。两组之间的总手术次数无显著差异（ERCP 中位数=2 次与 PTC 中位数=2.5 次，p=0.83）。与需要 ERCP 的患者相比，需要 PTBD 的患者中有 21%在接受 PTBD 后需要再次 ERCP，而需要 ERCP 的患者中有 25%在接受 ERCP 后需要再次 PTBD（p=1.00）。两组间的手术成功率（97%ERCP 与 93%PTBD，p=0.27）和胆管炎发生率（22%ERCP 与 17%PTBD，p=0.58）相似。两组患者自初始干预以来的住院次数无显著差异（ERCP 中位数=1 次与 PTC 中位数=3.5 次，p=0.052）。
在 CC 合并胆道梗阻的患者中，初始 ERCP 联合支架置入和初始 PTBD 均是安全有效的胆道减压方法。在具有先进内镜能力的中心，应考虑在这些患者中采用初始 ERCP 和支架置入来缓解胆道梗阻。
