Risk factors of ineffective drainage in uncovered self-expandable metal stenting for unresectable malignant hilar biliary strictures
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Koji Takahashi1, Toshio Tsuyuguchi1, Atsushi Saiga2, Takuro Horikoshi2, Yoshihiko Ooka1, Harutoshi Sugiyama1, Masato Nakamura1, Junichiro Kumagai1, Mutsumi Yamato1, Yotaro Iino1, Ayako Shingyoji1, Hiroshi Ohyama1, Shin Yasui1, Rintaro Mikata1, Yuji Sakai1 and Naoya Kato1
1Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
2Department of Radiology, Graduate School of Medicine, Chiba University, Chiba, Japan
Koji Takahashi, email: email@example.com
Keywords: cholangiopancreatography; drainage; endoscopic retrograde; risk factor; stent
Received: April 21, 2018 Accepted: May 24, 2018 Published: June 15, 2018
Aim: In this study, we assessed the factors contributing to ineffective drainage in the initial transpapillary uncovered self-expandable metal stent (USEMS) placements in patients with unresectable malignant hilar biliary strictures (UMHBSs) (Bismuth type II or higher).
Methods: This was a retrospective, single-center study. A total of 97 patients with UMHBSs who underwent technically successful initial USEMS placements using endoscopic retrograde cholangiopancreatography (ERCP) were classified into the effective drainage group (n = 73) or the ineffective drainage group (n = 24). We then compared group characteristics, clinical outcomes, and drained liver volumes. Drained liver volume was measured by using computed tomography volumetry. The definition of effective biliary drainage was a 50% decrease in the serum total bilirubin level or normalization of the level within 14 days of stent placement.
Results: Univariate analysis showed that ineffective drainage was associated with the pre-ERCP serum total bilirubin level (P = 0.0075), pre-ERCP serum albumin level (P = 0.042), comorbid liver cirrhosis (P = 0.010), drained liver volume (P = 0.0010), and single stenting (P = 0.022). Multivariate analysis identified comorbid liver cirrhosis (adjusted odds ratio [OR], 5.79; 95% confidence interval [CI], 1.30–25.85; P = 0.022) and drained liver volume < 50% (adjusted OR, 5.50; 95% CI, 1.50–20.25; P = 0.010) as independent risk factors of ineffective drainage.
Conclusion: Comorbid liver cirrhosis and a drained liver volume < 50% contributed significantly to ineffective drainage in the initial transpapillary USEMS placements for UMHBSs.
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