Endoscopic Endoprosthesis Insertion in Unresectable Hilar Cholangiocarcinoma Patient

Abstract

Objective: Hilar cholangiocarcinoma is one of the most common causes of biliary tract obstruction in Thailand. However, in most patients, the tumors are unresectable. Endoscopic retrograde cholangiopancreatography (ERCP) with endoprosthesis insertion can provide effective internal biliary drainage in these patients; however, there are still some controversy regarding the complications, success rate and technical aspect of this approach. The aim of this study was to report results of palliative endoscopic endoprosthesis insertion using plastic stents in unresectable hilar cholangiocarcinoma.
Methods: We analyzed 72 sessions of ERCP with plastic stent insertion in 61 patients with unresectable hilar cholangiocarcinoma, treated at the Endoscopic Unit, Department of Surgery, Siriraj Hospital from 1999-2001. Statistical analysis were done using chi-square test.
Results: In 72 sessions of ERCP with plastic stent insertion, overall successful drainage was 48%. Early complication was found in 13 sessions (18%) with cholangitis 13.9%, pancreatitis 2.8%, bleeding 2.8% and intra-abdominal collection 2.8%. Unilateral stent insertion was done in 94% (right side 43.4%, left side 49.1%) and bilateral stent insertion was performed in 7.5%. The success rate of right duct stent insertion was 63.1% while that of left duct stent insertion was 36.4% (p<0.01). Mortality rate was 2.98%.
Conclusion: Endoscopic endoprosthesis insertion using plastic stent is an effective method for palliative biliary drainage in patients with unresectable hilar cholangiocarcinoma with acceptable morbidity and mortality rate.