OBJECTIVES: The objective of this study was to identify the most appropriate endoscopic biliary drainage method in patients with pancreatic head cancer. METHODS: A prospectively collected database comprising 122 consecutive patients who underwent pancreatoduodenectomy, including 72 patients treated by endoscopic retrograde biliary drainage (ERBD) and 50 patients treated by endoscopic nasobiliary drainage (ENBD) procedures, was analyzed. RESULTS: All bile cultures collected intraoperatively were positive in the ERBD group, and the positive rates of drainage fluid cultures on postoperative days 1, 3, and 5 and the incidence of postoperative abdominal abscess formation were significantly higher than those in the ENBD group. Moreover, ERBD was identified as an independent predictive factor for postoperative pancreatic fistula (POPF) formation (hazards ratio, 11.81; P < 0.001). The receiver operating characteristic curve analysis for the preoperative drainage period in the ERBD group revealed that the determined cutoff level for the onset of POPF was 29 days. CONCLUSIONS: Endoscopic retrograde biliary drainage resulted in more frequent postoperative complications, including POPF, compared with ENBD. Postoperative pancreatic fistula is more likely to occur if the ERBD period exceeds 1 month in patients scheduled to undergo pancreatoduodenectomy.
OBJECTIVES: The objective of this study was to identify the most appropriate endoscopic biliary drainage method in patients with pancreatic head cancer. METHODS: A prospectively collected database comprising 122 consecutive patients who underwent pancreatoduodenectomy, including 72 patients treated by endoscopic retrograde biliary drainage (ERBD) and 50 patients treated by endoscopic nasobiliary drainage (ENBD) procedures, was analyzed. RESULTS: All bile cultures collected intraoperatively were positive in the ERBD group, and the positive rates of drainage fluid cultures on postoperative days 1, 3, and 5 and the incidence of postoperative abdominal abscess formation were significantly higher than those in the ENBD group. Moreover, ERBD was identified as an independent predictive factor for postoperative pancreatic fistula (POPF) formation (hazards ratio, 11.81; P < 0.001). The receiver operating characteristic curve analysis for the preoperative drainage period in the ERBD group revealed that the determined cutoff level for the onset of POPF was 29 days. CONCLUSIONS: Endoscopic retrograde biliary drainage resulted in more frequent postoperative complications, including POPF, compared with ENBD. Postoperative pancreatic fistula is more likely to occur if the ERBD period exceeds 1 month in patients scheduled to undergo pancreatoduodenectomy.
Authors: Benjamin Müssle; Sebastian Hempel; Christoph Kahlert; Marius Distler; Jürgen Weitz; Thilo Welsch Journal: World J Surg Date: 2018-09 Impact factor: 3.352