Research Papers:

Risk factors of ineffective drainage in uncovered self-expandable metal stenting for unresectable malignant hilar biliary strictures

Koji Takahashi _, Toshio Tsuyuguchi, Atsushi Saiga, Takuro Horikoshi, Yoshihiko Ooka, Harutoshi Sugiyama, Masato Nakamura, Junichiro Kumagai, Mutsumi Yamato, Yotaro Iino, Ayako Shingyoji, Hiroshi Ohyama, Shin Yasui, Rintaro Mikata, Yuji Sakai and Naoya Kato

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Oncotarget. 2018; 9:28185-28194. https://doi.org/10.18632/oncotarget.25598

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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

Correspondence to:

Koji Takahashi, email: [email protected]

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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