Nonsurgical management of primary cholangiocarcinoma. Retrospective analysis of 40 cases.

Forty patients with cholangiocarcinoma (23 men, 17 women) underwent nonsurgical palliative biliary drainage over a period of 12 years. All were surgically unfit or had unresectable disease. All were jaundiced at presentation with a mean serum bilirubin of 11.5 +/- 1.9 mg/dl. Thirty patients (75%) had hilar obstruction. Twenty-eight were drained percutaneously, three endoscopically and nine by a combined endoscopic and percutaneous procedure. Technical success was 97.5%. Final mean bilirubin was 1.5 +/- 0.4 mg/dl. Minor complications occurred in 10 (25%) patients, and major complications in four (10%). Procedure-related mortality was 2.5% with a 30-day mortality of 7.5%. Mean survival was 8.2 +/- 0.5 months. Stent changes were required in eight patients. In patients with inoperable or unresectable cholangiocarcinoma, percutaneous or endoscopic biliary drainage offers effective palliation.