Abstract
Background: The necessity for drainage of both liver lobes in tumors arising at the biliary bifurcation
is controversial. The aim of this study was to compare the outcome of unilateral versus
bilateral drainage in patients with biliary obstruction at the hilum. Methods: One hundred fifty-seven consecutive patients with primary cholangiocarcinoma, gallbladder
cancer, or periportal lymph node metastases were randomly allocated to unilateral
(group A) or bilateral (group B) hepatic duct drainage. Results: In intention-to treat analysis, group A had a significantly higher rate of successful
endoscopic stent insertion than group B (88.6% vs. 76.9%, p = 0.041). Group B had a significantly higher rate of complications than group A (26.9%
vs. 18.9%, p = 0.026) because of the higher rate of early cholangitis (16.6% vs. 8.8%, p = 0.013). In per-protocol analysis the rate of successful drainage, complications,
and mortality did not differ between the two groups. Median survival did not differ
between the two groups but was significantly different for patients with cholangiocarcinoma
and those with gallbladder cancer versus patients with metastatic tumors (p = 0.0247). Conclusion: The insertion of more than one stent would not appear justified as a routine procedure
in patients with biliary bifurcation tumors. (Gastrointest Endosc 2001;53:547-53.)
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Risk factors for septicemia following endoscopic biliary stent.Gastroenterology. 1991; 101: 1374-1381
- Biliary endoprosthesis in tumors at the hepatic duct bifurcation.Eur J Radiol. 1986; 6: 275-279
- A comparison or right versus left hepatic endoprosthesis insertion in malignant hilar biliary obstruction.Endoscopy. 1989; 21: 266-271
- Long-term follow-up of patients with hilar malignant stricture treated by endoscopic internal biliary drainage.Gastrointest Endosc. 1988; 34: 95-101
- Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage.Gastrointest Endosc. 1998; 47: 354-362
- Palliation of proximal malignant biliary obstruction by endoscopic endoprosthesis insertion.Gut. 1991; 32: 685-689
- Endoscopic biliary therapy using the combined percutaneous and endoscopic technique.Gastroenterology. 1989; 96: 1180-1186
- Management of malignant hilar biliary obstruction by endoscopy.Dig Dis Sci. 1992; 37: 778-783
- Experience with a combined percutaneous and endoscopic approach to stent insertion in malignant obstructive jaundice.Lancet. 1987; 2: 1449-1452
- Endoscopic stenting for malignant biliary obstruction.Arch Surg. 1995; 130: 204-207
- Resection or palliation: priority of surgery in the treatment of hilar cancer.World J Surg. 1988; 12: 39-47
- Endoscopic sphincterotomy complications and their management: an attempt at consensus.Gastrointest Endosc. 1991; 37: 383-393
- Management strategies resection for hilar cholangiocarcinoma.Ann Surg. 1992; 215: 31-38
- Changing trends in the management of extrahepatic cholangiocarcinoma.Br J Surg. 1993; 80: 1434-1439
- Recent advances in the management of cholangiocarcinoma.Sein Liver Dis. 1994; 14: 109-114
- Surgical approaches to cholangiocarcinoma at confluence of hepatic ducts.Lancet. 1984; 1: 66-69
- Biliary carcinoma—a review of 109 cases.Am J Surg. 1984; 147: 503-509
- Segment III cholangiojejunostomy for palliation of malignant hilar obstruction.Br J Surg. 1994; 81: 1639-1641
Article info
Publication history
Accepted:
December 1,
2000
Received in revised form:
July 31,
2000
Received:
April 11,
2000
Footnotes
☆Reprint requests: Dott. Giovanni D. De Palma, Via De Gasperi n. 7, 80033 Cicciano, Naples, Italy.
☆☆Gastrointest Endosc 2001;53:547-53
Identification
Copyright
© 2001 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
