Hepatocellular carcinoma with obstructive jaundice: Biliary drainage and multimodal therapy

Table 2 Source-verified clinical outcomes in selected hepatocellular carcinoma-specific biliary drainage studies

Ref.	Cohort and drainage	Clinical response definition	Verified drainage results	Key findings
Lee et al[4], 2002	Retrospective; 22 patients; PTBD	> 50% reduction in total bilirubin within 4 weeks	Good response: 13/22 (59.1%)	Lower baseline bilirubin favored response; survival was not reported in the verified abstract
Hong et al[23], 2008	Retrospective; 15 patients, 19 sessions; percutaneous SEMS	≥ 30% decrease in total bilirubin or total bilirubin < 2 mg/dL	Technical: 15/15 (100.0%); clinical: 11/15 (73.3%)	Major complications: 2/19 sessions (10.5%); mean stent patency: 149.8 days (range: 12-790 days)
Cho et al[19], 2011	Retrospective; 68 patients; ERBD or PTBD	> 30% decrease in total bilirubin within 4 weeks	Effective drainage: 51.5% (numerator not stated in the verified abstract)	Additional HCC treatment was more frequent after effective drainage; mean survival: 247 days vs 44 days
Choi et al[24], 2012	Retrospective; 60 patients; ERBD 29, PTBD 31	Study-defined successful drainage	ERBD: 22/29 (75.9%); PTBD: 15/31 (48.4%)	Median patency: 82 days vs 37 days; median survival after successful vs unsuccessful drainage: 143 days vs 38 days
Choi et al[7], 2013	Retrospective; 60 patients; ERBD or PTBD	Study-defined successful drainage	Successful drainage: 39/60 (65.0%)	TACE was given to 17/39 responders; median survival: 410 days vs 77 days for TACE vs conservative care, with major selection bias
Lu et al[22], 2013	Retrospective; 16 patients; PTBD with external/internal drainage or covered stent	Improvement in clinical symptoms and quality of life	Technical: 16/16 (100.0%); symptom/quality-of-life improvement: 12/16 (75.0%)	Immediate biliary hemorrhage: 5/16; hemorrhage with infection: 3/16; median survival: 199.5 days (mean: 203.7 days)
Choi et al[25], 2013	Retrospective ITT; 111 patients; attempted endoscopic drainage	Study-defined favorable response	Favorable response: 46/111 (41.4%); cannulation failed in 5/111	Further HCC treatment: 40/46 responders (87.0%); median survival: 8.7 months vs 1.3 months for responders vs nonresponders
Sugiyama et al[20], 2014	Retrospective; 36 patients; endoscopic stenting	≥ 50% reduction in total bilirubin	Technical: 36/36 (100.0%); clinical: 27/36 (75.0%)	No early complications; late complications: 13/36 (36.1%); median patency: 43 days; median survival: 150 days vs 22 days
Chung et al[17], 2015	Retrospective; 96 patients; SEMS 36, plastic stent 60	Study-defined successful drainage	SEMS: 25/36 (69.4%); plastic: 39/60 (65.0%)	Adverse events: 6/36 (16.7%) vs 13/60 (21.7%); median patency: 60 days vs 68 days; median survival: 48 days vs 123 days
Woo et al[18], 2017	Retrospective; 74 patients, 76 attempted procedures; endoscopic drainage	Total bilirubin < 3 mg/dL	Technical: 70/76 (92.1%); clinical: 25/70 (35.7%)	Post-drainage HCC treatment was associated with survival; median survival: 28 days overall. An internally inconsistent re-aggravation percentage was not reproduced
Matsumi et al[16], 2021	Multicenter retrospective; 107 patients; endoscopic drainage	≥ 30% reduction in jaundice after technical success; cholangitis resolution when applicable	Technical: 105/107 (98.1%); clinical: 85/105 (81.0%)	ERC-related complications: 3/107 (2.8%); 41/107 received HCC treatment after EBD; median survival: 5.0 months vs 0.93 months
Wang et al[21], 2022	Multicenter retrospective; 138 patients; PTBD	At 4 weeks: Any total bilirubin decrease or nadir < 5, < 3, or < 2 mg/dL as separate endpoints	No single pooled clinical-success rate was reported	Internal prediction-model study restricted to HBV-related cirrhosis; external validation is required
Tachi et al[26], 2025	Retrospective; 10 patients, 14 attempts, 11 evaluable procedures; EUS-HGS	Improved cholangitis or ≥ 50% reduction in total bilirubin within 4 weeks	Technical: 13/14 (92.9%); clinical: 10/11 (90.9%); ≥ 50% reduction by 2 weeks: 8/11 (72.7%)	Mild adverse events: 3/11 (27.3%); no bleeding; survival was not reported

Percentages were recalculated to one decimal place when numerators and denominators were available. Between-study response rates are not directly comparable because definitions, anatomy, hepatic reserve, and denominators differed. PTBD: Percutaneous transhepatic biliary drainage; SEMS: Self-expandable metal stent; ERBD: Endoscopic retrograde biliary drainage; HCC: Hepatocellular carcinoma; TACE: Transarterial chemoembolization; ITT: Intention-to-treat; ERC: Endoscopic retrograde cholangiography; EBD: Endoscopic biliary drainage; HBV: Hepatitis B virus; EUS-HGS: Endoscopic ultrasound-guided hepaticogastrostomy.