Clinical outcomes of initial inside stenting for preoperative malignant hilar biliary obstruction in patients with jaundice.

PURPOSE: Endoscopic nasobiliary drainage (ENBD) is a widely used primary approach for preoperative endoscopic biliary drainage (PEBD) for malignant hilar biliary obstruction (MHBO) although the utility of inside stenting (IS) remains unknown. This study aimed to compare the clinical outcomes of IS and ENBD as the initial PEBD.

METHODS

This retrospective, single-center study included patients with MHBO who underwent IS or ENBD as the initial PEBD and before laparotomy for radical surgical resection at the study institution. The primary outcome was the clinical success rate of the initial PEBD method.

RESULTS

The study included 28 and 38 patients who underwent IS and ENBD, respectively, for initial PEBD. The clinical success rates in patients who underwent IS and ENBD were 78.6% and 97.4%, respectively (P = 0.04). Clinical failure was more frequent in patients with jaundice undergoing IS (42.9%) than in those without jaundice undergoing IS and those with or without jaundice undergoing ENBD (0-4.2%; P < 0.01). The rates of cholangitis and PEBD-related adverse events, the cumulative incidence of PEBD dysfunction, and postoperative survival in patients undergoing IS and ENBD did not differ to a statistically significant extent.

CONCLUSIONS

Clinical failure of initial PEBD was more frequent in patients with jaundice undergoing IS than in those undergoing ENBD during the initial preoperative period of workup and drainage period.