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Open Access 01-01-2010 | Original Article

Endoscopic and Percutaneous Preoperative Biliary Drainage in Patients with Suspected Hilar Cholangiocarcinoma

Authors: Jaap J. Kloek, Niels A. van der Gaag, Yalda Aziz, Erik A. J. Rauws, Otto M. van Delden, Johan S. Lameris, Olivier R. C. Busch, Dirk J. Gouma, Thomas M. van Gulik

Published in: Journal of Gastrointestinal Surgery | Issue 1/2010

Abstract

Introduction

Controversy exists over the preferred technique of preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCCA) requiring major liver resection. The current study compared outcomes of endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) in patients with resectable HCCA.

Methods

One hundred fifteen consecutive patients were explored for HCCA between 2001 and July 2008 and assigned by initial PBD procedure to either EBD or PTBD.

Results

Of these patients, 101 (88%) underwent PBD; 90 patients underwent EBD as primary procedure, and 11 PTBD. The technical success rate of initial drainage was 81% in the EBD versus 100% in the PTBD group (P = 0.20). Stent dislocation was similar in the EBD and PTBD groups (23% vs. 20%, P = 0.70). Infectious complications were significantly more common in the endoscopic group (48% vs. 9%, P < 0.05). Patients in the EBD group underwent more drainage procedures (2.8 vs. 1.4, P < 0.01) and had a significantly longer drainage period until laparotomy (mean 15 weeks vs. 11 weeks in the PTBD group; P < 0.05). In 30 patients, EBD was converted to PTBD due to failure of the endoscopic approach.

Conclusions

Preoperative percutaneous drainage could outperform endoscopic stent placement in patients with resectable HCCA, showing fewer infectious complications, using less procedures.

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Title: Endoscopic and Percutaneous Preoperative Biliary Drainage in Patients with Suspected Hilar Cholangiocarcinoma
Authors: Jaap J. Kloek
Niels A. van der Gaag
Yalda Aziz
Erik A. J. Rauws
Otto M. van Delden
Johan S. Lameris
Olivier R. C. Busch
Dirk J. Gouma
Thomas M. van Gulik
Publication date: 01-01-2010
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 1/2010
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-009-1009-1

At a glance: The STEP trials

Springer Medicine

Endoscopic and Percutaneous Preoperative Biliary Drainage in Patients with Suspected Hilar Cholangiocarcinoma

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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