Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina.
Division of Gastroenterology and Liver Disease, Case Western Reserve University, Cleveland, Ohio.
Clin Gastroenterol Hepatol. 2021 Jun;19(6):1282-1284. doi: 10.1016/j.cgh.2020.05.035. Epub 2020 May 23.
Percutaneous transhepatic biliary drainage (PTBD) and endoscopic retrograde cholangiopancreatography (ERCP) are widely accepted but competing approaches for the management of malignant obstruction at the hilum of the liver. ERCP is favored in the United States on the basis of high success rates for non-hilar indications, the perceived safety and superior tissue sampling capability of ERCP relative to PTBD, and the avoidance of external drains that are undesirable to patients. A recent randomized controlled trial (RCT) comparing the 2 modalities in patients with resectable hilar cholangiocarcinoma was terminated prematurely because of higher mortality in the PTBD group. In contrast, most observational data suggest that PTBD is superior for achieving complete drainage. Because the preferred procedure remains uncertain, we aimed to compare PTBD and ERCP as the primary intervention in patients with cholestasis due to malignant hilar obstruction (MHO).
经皮经肝胆道引流术 (PTBD) 和内镜逆行胰胆管造影术 (ERCP) 是广泛接受的治疗肝门部恶性梗阻的方法，但它们互为竞争。在美国，ERCP 因其在非肝门部适应证上的高成功率、与 PTBD 相比被认为更安全且具有更好的组织取样能力，以及避免了患者不希望使用的外部引流管而受到青睐。最近一项比较 2 种方法治疗可切除肝门部胆管癌患者的随机对照试验 (RCT) 因 PTBD 组死亡率较高而提前终止。相比之下，大多数观察性数据表明 PTBD 更有利于实现完全引流。由于首选方法仍不确定，我们旨在比较 PTBD 和 ERCP 作为恶性肝门部梗阻 (MHO) 所致胆汁淤积患者的主要干预措施。
