Abstract
Background: Advanced and incurable Klatskin tumors of Bismuth-type III and IV cause obstructive
jaundice. Palliation of patients with Klatskin tumors is usually carried out by bilateral
endoscopic stent placement. Endoscopic retrograde cholangiography (ERC) in such patients
is associated with a comparatively high morbidity and mortality mainly due to postprocedure
bacterial cholangitis. To reduce ERC-related complications the outcome of replacing
ERC with magnetic resonance cholangiopancreatography (MRCP) was investigated. Subsequently,
unilateral contrast injection and stent placement were performed, thus avoiding bilateral
contrast injection and stent insertion. Methods: Patients thought to have a Klatskin tumor underwent clinical evaluation, laboratory,
and noninvasive imaging studies before ERC. Patients were enrolled in this feasibility
study if investigators agreed with the clinical diagnosis of an advanced and incurable
Klatskin tumor. MRCP images were used to determine the predominate ductal drainage
for the liver segments thus directing stent placement. Based on these findings, unilateral
ERC and subsequent unilateral stent placement were performed. Antibiotics were not
given before ERC. Amsterdam-type stents (10F) were placed and replaced routinely at
2 months. In cases of earlier occlusion, the stents were replaced immediately. Results: Thirty-five patients underwent MRCP, ERC, and unilateral stent deployment. Two further
patients enrolled after MRCP were withdrawn because ERC could not be carried out.
In 35 patients with unilateral stents bilirubin levels decreased (18.9 ± 6.3 mg/dL
to 3.2 ± 2.3 mg/dL) and jaundice resolved in 86%. After first stent deployment, post-ERC
bacterial cholangitis occurred in 6% (2 of 35) of patients. Conclusions: This new method of MRCP-guided endoscopic unilateral stent placement could reduce
ERC-related complications caused by initial stent deployment.The results of this study
justify a randomized prospective comparative trial. (Gastrointest Endosc 2001;53:40-6.)
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Article info
Publication history
Accepted:
September 7,
2000
Received in revised form:
March 21,
2000
Received:
February 15,
2000
Footnotes
☆Reprint requests: R. E. Hintze, MD, Humboldt University, Universitätsklinikum Charité, Campus Virchow-Klinikum, Zentrale Interdisziplinäre Endoskopie, Department of Internal Medicine, Division of Hepatology and Gastroenterology, Augustenburger Platz 1, 13353 Berlin, Germany.
☆☆Gastrointest Endosc 2001;53:40-6
Identification
Copyright
© 2001 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
