ERCP of uncertain benefit in cancer patients with large volume hepatic tumor burden: a tertiary referral cancer center experience. (Is the glass half empty or half full?)

Aims Cancer patients with large volume hepatic tumor burden (LVHTB), hyperbilirubinemia and bile duct obstruction are frequently referred for ERCP with uncertain benefit. In most cases a bilirubin of < 2mg/dL is needed for systemic chemotherapy. The aim of this study was to evaluate the outcomes of patients with LVHTB referred for ERCP.

Methods A retrospective review was performed on all patients with LVHTB referred for ERCP from 7/2021-9/2022. LVHTB was defined as estimated >50% liver involvement as assessed by cross-sectional imaging. Appropriate candidates for ERCP were selected based on the presence of dilated bile ducts within the remnant liver amenable to endoscopic drainage. The primary outcomes included technical success (successful biliary stent placement), clinical success (bilirubin normalization <2mg/dL) and subsequent treatment eligibility.

Results Of 170 patients with LVHTB referred, 81 (47.6%) underwent ERCP and 89 (52.4%) were declined. Technical success was 93.8% (76/81). Clinical success was 27.2% (22/81). Percutaneous transhepatic biliary drainage was subsequently performed in 14 with a clinical success of 14.3% (2/14). Only 21.0% (17/81) received subsequent chemotherapy treatment. The remainder went to hospice 72.8% (59/81) or did not follow-up 6.2% (5/81). To date, 76.5% (62/81) passed away within a median of 32days (range 8-383) after ERCP ([Table 1]).

Table 1

Conclusions Based on our experience, less than half of referrals with LVHTB are candidates for ERCP. Despite high technical success, only one in four patients will have adequate response to allow treatment. This information should prove useful to setting expectations of patients and referring providers.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
14 April 2023