Step-wise endoscopic approach to palliative bilateral biliary drainage for unresectable advanced malignant hilar obstruction

Jin Ho Choi, Sang Hyub Lee, Min Su You, Bang sup Shin, Young Hoon Choi, Jinwoo Kang, Sunguk Jang, Woo Hyun Paik, Ji Kon Ryu, Yong Tae Kim

Research output: Contribution to journalArticle

Abstract

The ideal type of stent utilized at index endoscopic retrograde cholangiopancreatography (ERCP) in management of malignant hilar obstruction (MHO) remains unclear. We aimed to determine the ideal stent choice in patients with MHO. In this retrospective study, patients with unresectable MHO were separated into the plastic stent (PS) group and the self-expandable metal stent (SEMS) group. The primary outcome was the risk and rate of rescue percutaneous transhepatic biliary drainage (PTBD). The secondary outcomes were the progression-free survival, the overall survival and the PTBD-free period (days). Thirty-six patients in the PS group and 38 patients in the SEMS group were enrolled. The risk for PTBD was higher in SEMS group (HR = 2.205, 95% C.I. 0.977–4.977, P = 0.057). The rate of PTBD was significantly lower in the PS group. (22.2% vs 50.0%, P = 0.017) There were no differences in overall survival and progression-free survival (410 and 269 in the PS group, 395 and 266 in the SEMS group, P = 0.663 and P = 0.757). The PTBD-free period was significantly longer in the PS group. (836.43 vs 586.40, P = 0.039) Although comparable in clinical efficacy, utilization of PS at index ERCP may reduce patient’s discomfort by avoiding PTBD and prolonging PTBD-free period in patients with MHO.

Original languageEnglish
Article number13207
JournalScientific Reports
Volume9
Issue number1
DOIs
StatePublished - 1 Dec 2019

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Stents
Drainage
Plastics
Endoscopic Retrograde Cholangiopancreatography
Disease-Free Survival
Survival
Retrospective Studies
Self Expandable Metallic Stents

Cite this

@article{14830bcd21224bb8a17d7ad6eeb6976e,
title = "Step-wise endoscopic approach to palliative bilateral biliary drainage for unresectable advanced malignant hilar obstruction",
abstract = "The ideal type of stent utilized at index endoscopic retrograde cholangiopancreatography (ERCP) in management of malignant hilar obstruction (MHO) remains unclear. We aimed to determine the ideal stent choice in patients with MHO. In this retrospective study, patients with unresectable MHO were separated into the plastic stent (PS) group and the self-expandable metal stent (SEMS) group. The primary outcome was the risk and rate of rescue percutaneous transhepatic biliary drainage (PTBD). The secondary outcomes were the progression-free survival, the overall survival and the PTBD-free period (days). Thirty-six patients in the PS group and 38 patients in the SEMS group were enrolled. The risk for PTBD was higher in SEMS group (HR = 2.205, 95{\%} C.I. 0.977–4.977, P = 0.057). The rate of PTBD was significantly lower in the PS group. (22.2{\%} vs 50.0{\%}, P = 0.017) There were no differences in overall survival and progression-free survival (410 and 269 in the PS group, 395 and 266 in the SEMS group, P = 0.663 and P = 0.757). The PTBD-free period was significantly longer in the PS group. (836.43 vs 586.40, P = 0.039) Although comparable in clinical efficacy, utilization of PS at index ERCP may reduce patient’s discomfort by avoiding PTBD and prolonging PTBD-free period in patients with MHO.",
author = "Choi, {Jin Ho} and Lee, {Sang Hyub} and You, {Min Su} and Shin, {Bang sup} and Choi, {Young Hoon} and Jinwoo Kang and Sunguk Jang and Paik, {Woo Hyun} and Ryu, {Ji Kon} and Kim, {Yong Tae}",
year = "2019",
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day = "1",
doi = "10.1038/s41598-019-48384-x",
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journal = "Scientific reports",
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Step-wise endoscopic approach to palliative bilateral biliary drainage for unresectable advanced malignant hilar obstruction. / Choi, Jin Ho; Lee, Sang Hyub; You, Min Su; Shin, Bang sup; Choi, Young Hoon; Kang, Jinwoo; Jang, Sunguk; Paik, Woo Hyun; Ryu, Ji Kon; Kim, Yong Tae.

In: Scientific Reports, Vol. 9, No. 1, 13207, 01.12.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Step-wise endoscopic approach to palliative bilateral biliary drainage for unresectable advanced malignant hilar obstruction

AU - Choi, Jin Ho

AU - Lee, Sang Hyub

AU - You, Min Su

AU - Shin, Bang sup

AU - Choi, Young Hoon

AU - Kang, Jinwoo

AU - Jang, Sunguk

AU - Paik, Woo Hyun

AU - Ryu, Ji Kon

AU - Kim, Yong Tae

PY - 2019/12/1

Y1 - 2019/12/1

N2 - The ideal type of stent utilized at index endoscopic retrograde cholangiopancreatography (ERCP) in management of malignant hilar obstruction (MHO) remains unclear. We aimed to determine the ideal stent choice in patients with MHO. In this retrospective study, patients with unresectable MHO were separated into the plastic stent (PS) group and the self-expandable metal stent (SEMS) group. The primary outcome was the risk and rate of rescue percutaneous transhepatic biliary drainage (PTBD). The secondary outcomes were the progression-free survival, the overall survival and the PTBD-free period (days). Thirty-six patients in the PS group and 38 patients in the SEMS group were enrolled. The risk for PTBD was higher in SEMS group (HR = 2.205, 95% C.I. 0.977–4.977, P = 0.057). The rate of PTBD was significantly lower in the PS group. (22.2% vs 50.0%, P = 0.017) There were no differences in overall survival and progression-free survival (410 and 269 in the PS group, 395 and 266 in the SEMS group, P = 0.663 and P = 0.757). The PTBD-free period was significantly longer in the PS group. (836.43 vs 586.40, P = 0.039) Although comparable in clinical efficacy, utilization of PS at index ERCP may reduce patient’s discomfort by avoiding PTBD and prolonging PTBD-free period in patients with MHO.

AB - The ideal type of stent utilized at index endoscopic retrograde cholangiopancreatography (ERCP) in management of malignant hilar obstruction (MHO) remains unclear. We aimed to determine the ideal stent choice in patients with MHO. In this retrospective study, patients with unresectable MHO were separated into the plastic stent (PS) group and the self-expandable metal stent (SEMS) group. The primary outcome was the risk and rate of rescue percutaneous transhepatic biliary drainage (PTBD). The secondary outcomes were the progression-free survival, the overall survival and the PTBD-free period (days). Thirty-six patients in the PS group and 38 patients in the SEMS group were enrolled. The risk for PTBD was higher in SEMS group (HR = 2.205, 95% C.I. 0.977–4.977, P = 0.057). The rate of PTBD was significantly lower in the PS group. (22.2% vs 50.0%, P = 0.017) There were no differences in overall survival and progression-free survival (410 and 269 in the PS group, 395 and 266 in the SEMS group, P = 0.663 and P = 0.757). The PTBD-free period was significantly longer in the PS group. (836.43 vs 586.40, P = 0.039) Although comparable in clinical efficacy, utilization of PS at index ERCP may reduce patient’s discomfort by avoiding PTBD and prolonging PTBD-free period in patients with MHO.

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U2 - 10.1038/s41598-019-48384-x

DO - 10.1038/s41598-019-48384-x

M3 - Article

C2 - 31519930

AN - SCOPUS:85072194504

VL - 9

JO - Scientific reports

JF - Scientific reports

SN - 2045-2322

IS - 1

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ER -