Efficacy of Biliary Stent Drainage and Factors Associated with Complications in Endoscopic Palliative Treatment of Patients with Hilar Cholangiocarcinoma
Keywords:
Biliary stent, Endoscopic biliary drainage, Hilar cholangiocarcinoma, Obstructive jaundiceAbstract
Introduction: Various types of stent drainage have been used for symptom alleviation in patients with unresectable hilar cholangiocarcinoma. However, its efficacy and factors associated with morbidity and mortality after the operation are unclear.
Methods: We carried out a retrospective cohort study of 100 unresectable hilar cholangiocarcinoma patients treated with endoscopic biliary drainage between January 2008 and December 2009. We aimed to identify complications, jaundice resolution rate, stent patency time, and patient's survival time and to evaluate factors associated with patients' morbidity and mortality.
Results: Plastic stents and self-expanding metallic stents (SEMS) were inserted in 12 patients and 88 patients respectively. Successful drainage was achieved in 70% of cases. Cholangitis occurred in 26% and 21 patients died within the first 30 days. Late complications occurred in 24 cases. The median patency times for plastic stent and SEMS were 57 days and 74 days respectively. The median survival times for patients with plastic stent and SEMS were 57 and 83 days respectively. Univariate analysis showed that successful drainage and albumin level less than 2 mg % were highly associated with the presence of cholangitis (P = 0.000 and P = 0.008 respectively) and associated with 30-day mortality rate (P = 0.00 and P = 0.012 respectively). After confirmation of the nine tested variables with the stent patency time and survival time using the Kaplan Mier and log rank test successful drainage and albumin level were associated with patency time and patients' survival times.
Conclusion: Incidence of morbidity was found to be relatively low. However, more than half died within 90 days. Albumin level and successful drainage were the significant factors related with patients' morbidity and mortality.
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