Malignant Hilar Biliary Strictures: Efficiency Of Endoscopic Drainage

Aims The endoscopic drainage (ED) of malignant hilar biliary strictures (MHBS) is often a challenge for the endoscopist with a significant failure rate.Our objective was to evaluate the efficacy of (ED) in (MHBS).

Methods The endoscopic drainage (ED) of malignant hilar biliary strictures (MHBS) is often a challenge for the endoscopist with a significant failure rate.Our objective was to evaluate the efficacy of (ED) in (MHBS).

Results Out of 240 EDs, 33 patients with MHBS were identified.The mean age of patients was 55.8 ±13.7 years,with a female predominance (sex-ratio F/M of 2.3). Clinically all patients had obstructive jaundice and pruritus.Strictures were due to perihilar cholangiocarcinoma in 16 cases (48.5 %), hepatic metastasis in 7 cases (30.4 %), extrinsic hilar invasion in 7 cases (3 pancreatic neck cancers,6 gallbladder cancers and 1 gastric cancers). BD was successful in 87.7 % and failure was recorded in 4 cases.BD failure causes were the inability to negotiate the guidewire through the stenosis in 2 cases, the lack of opacifying of the bile duct upstream of the stenosis in one case, and the failure of passing a dilation balloon in one case.The drainage failure rate was 9.5 % in case of bilirubin< 25 mg/dl and 28.6 % while >25 mg/dl, this difference was not statistically significant(p=0.25).The drainage success rate regarding the Bismuth classification was 100 % for stage I, 88.9 % for type II, 83 % for type III, and 66.7 % for type IV.This difference was not statistically significant (p=0.65).At postoperative, 3 patients (9 %) presented mild cholangitis with good outcomes under medical treatment.

Conclusions ED is the gold standard for treatment of MHBS with a success rate that exceeds 80 % in our experience,the tumor stage and the bilirubin level might not affect the success of the drainage but a large study with a high number of patients is necessary to assess the impact of these two factors.

Citation El Mountassir M, Borahma M, Lagdali N et al. eP334 MALIGNANT HILAR BILIARY STRICTURES: EFFICIENCY OF ENDOSCOPIC DRAINAGE. Endoscopy 2021; 53: S206.

Publication History

Article published online:
19 March 2021