Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. May 10, 2016; 8(9): 385-390
Published online May 10, 2016. doi: 10.4253/wjge.v8.i9.385
Lower incidence of complications in endoscopic nasobiliary drainage for hilar cholangiocarcinoma
Kazumichi Kawakubo, Hiroshi Kawakami, Masaki Kuwatani, Shin Haba, Taiki Kudo, Yoko A Taya, Shuhei Kawahata, Yoshimasa Kubota, Kimitoshi Kubo, Kazunori Eto, Nobuyuki Ehira, Hiroaki Yamato, Manabu Onodera, Naoya Sakamoto
Kazumichi Kawakubo, Hiroshi Kawakami, Masaki Kuwatani, Shin Haba, Taiki Kudo, Yoko A Taya, Shuhei Kawahata, Yoshimasa Kubota, Kimitoshi Kubo, Kazunori Eto, Nobuyuki Ehira, Hiroaki Yamato, Manabu Onodera, Naoya Sakamoto, Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo 0608638, Japan
Author contributions: Kawakubo K designed and performed the study and wrote the paper; Kawakami H and Kuwatani M designed the study and supervised the writing of the report; Haba S, Kudo T, Taya YA, Kawahata S, Kubota Y, Kubo K, Eto K, Ehira N, Yamato H and Onodera M collected and analyzed the data; and Sakamoto N approved the final version of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Hokkaido University Hospital.
Informed consent statement: Patients were not required to give informed consent to participate in the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. For full disclosure, the details of the study are published on the home page of Hokkaido University Hospital.
Conflict-of-interest statement: The authors have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kazumichi Kawakubo, MD, PhD, Assistant Professor, Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo 0608638, Japan. kkawakubo-gi@umin.ac.jp
Telephone: +81-11-7161161 Fax: +81-11-7067867
Received: December 21, 2015
Peer-review started: December 22, 2015
First decision: January 30, 2016
Revised: February 15, 2016
Accepted: March 14, 2016
Article in press: March 16, 2016
Published online: May 10, 2016
Processing time: 136 Days and 20.1 Hours
Abstract

AIM: To identify the most effective endoscopic biliary drainage technique for patients with hilar cholangiocarcinoma.

METHODS: In total, 118 patients with hilar cholangiocarcinoma underwent endoscopic management [endoscopic nasobiliary drainage (ENBD) or endoscopic biliary stenting] as a temporary drainage in our institution between 2009 and 2014. We retrospectively evaluated all complications from initial endoscopic drainage to surgery or palliative treatment. The risk factors for biliary reintervention, post-endoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis, and percutaneous transhepatic biliary drainage (PTBD) were also analyzed using patient- and procedure-related characteristics. The risk factors for bilateral drainage were examined in a subgroup analysis of patients who underwent initial unilateral drainage.

RESULTS: In total, 137 complications were observed in 92 (78%) patients. Biliary reintervention was required in 83 (70%) patients. ENBD was significantly associated with a low risk of biliary reintervention [odds ratio (OR) = 0.26, 95%CI: 0.08-0.76, P = 0.012]. Post-ERCP pancreatitis was observed in 19 (16%) patients. An absence of endoscopic sphincterotomy was significantly associated with post-ERCP pancreatitis (OR = 3.46, 95%CI: 1.19-10.87, P = 0.023). PTBD was required in 16 (14%) patients, and Bismuth type III or IV cholangiocarcinoma was a significant risk factor (OR = 7.88, 95%CI: 1.33-155.0, P = 0.010). Of 102 patients with initial unilateral drainage, 49 (48%) required bilateral drainage. Endoscopic sphincterotomy (OR = 3.24, 95%CI: 1.27-8.78, P = 0.004) and Bismuth II, III, or IV cholangiocarcinoma (OR = 34.69, 95%CI: 4.88-736.7, P < 0.001) were significant risk factors for bilateral drainage.

CONCLUSION: The endoscopic management of hilar cholangiocarcinoma is challenging. ENBD should be selected as a temporary drainage method because of its low risk of complications.

Keywords: Hilar cholangiocarcinoma; Endoscopic nasobiliary drainage; Endoscopic biliary stenting; Endoscopic sphincterotomy; Complications

Core tip: This retrospective study evaluated the risk of complications associated with a temporary endoscopic biliary drainage for hilar cholangiocarcinoma. Endoscopic nasobiliary drainage (ENBD) had a significantly lower incidence of biliary complications than biliary stenting. Endoscopic sphincterotomy significantly reduced the rate of post-endoscopic retrograde cholangiopancreatography pancreatitis, but was associated with bilateral drainage. Therefore, ENBD should be selected as a temporary biliary drainage method for patients with hilar cholangiocarcinoma.