Hirotoshi Ishiwatari1, Takanori Kawabata2, Hiroki Kawashima3, Yousuke Nakai4, Shin Miura5, Hironari Kato6, Hideyuki Shiomi7,8, Nao Fujimori9, Takeshi Ogura10, Osamu Inatomi11, Kensuke Kubota12, Toshio Fujisawa13, Mamoru Takenaka14, Hiroshi Mori3, Kensaku Noguchi4, Yuki Fujii6, Teiichi Sugiura15, Noboru Ideno16, Tomoki Nakafusa16, Atsushi Masamune5, Hiroyuki Isayama13, Naoki Sasahira17. 1. Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan. ishihiro481019@gmail.com. 2. Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan. 3. Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan. 4. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 5. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan. 6. Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan. 7. Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan. 8. Division of Gastroenterology and Hepato-Biliary-Pancreatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan. 9. Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 10. Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University (Osaka Medical College), Osaka, Japan. 11. Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Otsu, Japan. 12. Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan. 13. Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan. 14. Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan. 15. Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan. 16. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 17. Division of Hepato-Biliary-Pancreatic Medicine, Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
Abstract
BACKGROUND: The appropriate method of preoperative endoscopic biliary drainage (EBD) for cholangiocarcinoma with hilar biliary obstruction remains controversial. The inside-stent technique is a method of placing plastic stents entirely inside the bile duct. Several studies of patients with unresectable stage have reported longer stent patency compared with conventional endoscopic biliary stenting (EBS). Inside-stent techniques have been introduced as a bridge-to-surgery option and as an alternative to conventional EBS. AIMS: We aimed to evaluate the clinical outcomes of inside stent use and conventional EBS. METHODS: During this retrospective multicenter study, we reviewed consecutive patients with cholangiocarcinoma who underwent radical surgery after conventional EBS or inside-stent insertion. Adverse event (AE) rates after EBD and post-surgical AEs were compared. A multivariable analysis was performed to identify factors affecting cholangitis after EBD. RESULTS: Conventional EBS and inside-stent procedures were performed for 56 and 73 patients, respectively. Patient backgrounds were similar between groups, except for percutaneous transhepatic portal vein embolization. The waiting time before surgery was similar between groups (28.5 days vs. 30 days). There were no significant differences in the cholangitis rate (21.4% vs. 26.0%; P = 0.68) and all AEs (25.0% vs. 30.1%; P = 0.56) between groups. The post-surgical AE rate was similar between the groups. The multivariable analysis found that preprocedural cholangitis was a risk factor for cholangitis after EBD (odds ratio: 5.67; 95% confidence interval: 1.61-19.9). CONCLUSIONS: The outcomes of inside-stent techniques and conventional EBS for the management of preoperative EBD are comparable for patients with cholangiocarcinoma.
BACKGROUND: The appropriate method of preoperative endoscopic biliary drainage (EBD) for cholangiocarcinoma with hilar biliary obstruction remains controversial. The inside-stent technique is a method of placing plastic stents entirely inside the bile duct. Several studies of patients with unresectable stage have reported longer stent patency compared with conventional endoscopic biliary stenting (EBS). Inside-stent techniques have been introduced as a bridge-to-surgery option and as an alternative to conventional EBS. AIMS: We aimed to evaluate the clinical outcomes of inside stent use and conventional EBS. METHODS: During this retrospective multicenter study, we reviewed consecutive patients with cholangiocarcinoma who underwent radical surgery after conventional EBS or inside-stent insertion. Adverse event (AE) rates after EBD and post-surgical AEs were compared. A multivariable analysis was performed to identify factors affecting cholangitis after EBD. RESULTS: Conventional EBS and inside-stent procedures were performed for 56 and 73 patients, respectively. Patient backgrounds were similar between groups, except for percutaneous transhepatic portal vein embolization. The waiting time before surgery was similar between groups (28.5 days vs. 30 days). There were no significant differences in the cholangitis rate (21.4% vs. 26.0%; P = 0.68) and all AEs (25.0% vs. 30.1%; P = 0.56) between groups. The post-surgical AE rate was similar between the groups. The multivariable analysis found that preprocedural cholangitis was a risk factor for cholangitis after EBD (odds ratio: 5.67; 95% confidence interval: 1.61-19.9). CONCLUSIONS: The outcomes of inside-stent techniques and conventional EBS for the management of preoperative EBD are comparable for patients with cholangiocarcinoma.
Authors: Mouen A Khashab; Katherine Kim; Susan Hutfless; Anne Marie Lennon; Anthony N Kalloo; Vikesh K Singh Journal: Dig Dis Sci Date: 2012-05-10 Impact factor: 3.199