Results of endoscopic biliary drainage in patients with malignant hilar stricture.

Autor:	Martins BC; Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology of Universidade de São Paulo, São Paulo, SP, Brazil. Electronic address: bcm.bruno@gmail.com., Perez CA; Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology of Universidade de São Paulo, São Paulo, SP, Brazil., Ruas JN; Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology of Universidade de São Paulo, São Paulo, SP, Brazil., Bento LH; Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology of Universidade de São Paulo, São Paulo, SP, Brazil., Mendonça EQ; Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology of Universidade de São Paulo, São Paulo, SP, Brazil., de Paulo GA; Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology of Universidade de São Paulo, São Paulo, SP, Brazil., Uemura RS; Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology of Universidade de São Paulo, São Paulo, SP, Brazil., Geiger SN; Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology of Universidade de São Paulo, São Paulo, SP, Brazil., de Lima MS; Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology of Universidade de São Paulo, São Paulo, SP, Brazil., Jukemura J; Division of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo. Department of Gastroenterology of Universidade de São Paulo, São Paulo, SP, Brazil., Ribeiro U Jr; Division of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo. Department of Gastroenterology of Universidade de São Paulo, São Paulo, SP, Brazil., Maluf-Filho F; Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology of Universidade de São Paulo, São Paulo, SP, Brazil.
Jazyk:	angličtina
Zdroj:	Clinics (Sao Paulo, Brazil) [Clinics (Sao Paulo)] 2023 Jan 19; Vol. 78, pp. 100153. Date of Electronic Publication: 2023 Jan 19 (Print Publication: 2023).
DOI:	10.1016/j.clinsp.2022.100153
Abstrakt:	In Malignant Hilar Biliary Stricture (MHBS) palliative biliary drainage is a frequent strategy, improving the quality of life, reducing pruritus, loss of appetite and relieving cholangitis. The endoscopic approach is an effective, although challenging procedure. This study aimed to evaluate technical and clinical success rates of biliary drainage by ERCP. This is a retrospective study including all patients with MHBS referred to Instituto do Cancer do Hospital de São Paulo (ICESP) submitted to biliary drainage by ERCP, between January 2010 and December 2017. Multivariable logistic regression was performed to evaluate predictors of clinical failure, as total bilirubin levels, Bismuth classification, number of hepatic sectors drained and presence of cholangitis. In total, 82 patients presenting unresectable MHBS were included in this study. 58.5% female and 41.5% male, with a mean age of 60±13 years. Bismuth classification grades II, IIIA, IIIB and IV were noted in 23.2%, 15.9%, 14.6% and 46.3%, respectively. Technical and clinical success was achieved in 92.7% and 53.7% respectively. At multivariable logistic-regression analyses, Bismuth IV strictures were related to higher clinical failure rates when compared to other strictures levels, with an Odds Ratio of 5.8 (95% CI 1.28‒20.88). In conclusion, endoscopic biliary drainage for malignant hilar biliary stricture had a high technical success but suboptimal clinical success rate. Proximal strictures (Bismuth IV) were associated with poor drainage outcomes. Competing Interests: Conflicts of interest The authors declare no conflicts of interest. (Copyright © 2022 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.)
Databáze:	MEDLINE
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