BACKGROUND:Endoscopic biliary drainage is the palliative treatment of choice in patients with malignant hilar biliary obstruction. Contrast injection can lead to cholangitis, whereas air cholangiography may have a lesser incidence of cholangitis. OBJECTIVE: The objective of the present study is to prospectively compare the efficacy and safety of air vs. dye cholangiogram in malignant hilar biliary obstruction. METHODS:Patients with type II and III malignant hilar biliary stricture were included in a prospectively randomized manner at a tertiary care center. Unilateral self-expanding metal stent was placed in patients with a malignant hilar block using either air or dye as a contrast medium. Outcome measures were successful deployment, successful drainage, early complications, and procedure-related and 30-day mortality. RESULTS:Forty-nine patients were randomized to air cholangiogram (25 patients, group A) or dye cholangiogram (24 patients, group B). Most of the patients had type II stricture (19 in group A and 20 in group B). Successful stenting and drainage were achieved in 25 (100 %) and 24 (96 %) in group A and 23 (95.8 %) and 22 (91.6 %) (p = ns), respectively. Cholangitis developed in 1 (4 %) and 4 (16.6 %) in group A and B, respectively (p < 0.05). There was no procedure-related or 30-day mortality. CONCLUSION: Use of air cholangiography was as safe and as effective as dye cholangiography in patients with malignant hilar biliary obstruction, and it decreased the risk of post-ERCP cholangitis.
RCT Entities:
BACKGROUND: Endoscopic biliary drainage is the palliative treatment of choice in patients with malignant hilar biliary obstruction. Contrast injection can lead to cholangitis, whereas air cholangiography may have a lesser incidence of cholangitis. OBJECTIVE: The objective of the present study is to prospectively compare the efficacy and safety of air vs. dye cholangiogram in malignant hilar biliary obstruction. METHODS:Patients with type II and III malignant hilar biliary stricture were included in a prospectively randomized manner at a tertiary care center. Unilateral self-expanding metal stent was placed in patients with a malignant hilar block using either air or dye as a contrast medium. Outcome measures were successful deployment, successful drainage, early complications, and procedure-related and 30-day mortality. RESULTS: Forty-nine patients were randomized to air cholangiogram (25 patients, group A) or dye cholangiogram (24 patients, group B). Most of the patients had type II stricture (19 in group A and 20 in group B). Successful stenting and drainage were achieved in 25 (100 %) and 24 (96 %) in group A and 23 (95.8 %) and 22 (91.6 %) (p = ns), respectively. Cholangitis developed in 1 (4 %) and 4 (16.6 %) in group A and B, respectively (p < 0.05). There was no procedure-related or 30-day mortality. CONCLUSION: Use of air cholangiography was as safe and as effective as dye cholangiography in patients with malignant hilar biliary obstruction, and it decreased the risk of post-ERCP cholangitis.
Authors: Giovanni D De Palma; Angelo Pezzullo; Maria Rega; Marcello Persico; Francesco Patrone; Luigi Mastantuono; Giovanni Persico Journal: Gastrointest Endosc Date: 2003-07 Impact factor: 9.427
Authors: M Ducreux; C Liguory; J F Lefebvre; O Ink; A Choury; J Fritsch; D Bonnel; S Derhy; J P Etienne Journal: Dig Dis Sci Date: 1992-05 Impact factor: 3.199
Authors: A A Polydorou; E M Chisholm; A A Romanos; J F Dowsett; P B Cotton; A R Hatfield; R C Russell Journal: Endoscopy Date: 1989-11 Impact factor: 10.093