Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2016; 22(14): 3793-3802
Published online Apr 14, 2016. doi: 10.3748/wjg.v22.i14.3793
Multicenter study of endoscopic preoperative biliary drainage for malignant distal biliary obstruction
Naoki Sasahira, Tsuyoshi Hamada, Osamu Togawa, Ryuichi Yamamoto, Tomohisa Iwai, Kiichi Tamada, Yoshiaki Kawaguchi, Kenji Shimura, Takero Koike, Yu Yoshida, Kazuya Sugimori, Shomei Ryozawa, Toshiharu Kakimoto, Ko Nishikawa, Katsuya Kitamura, Tsunao Imamura, Masafumi Mizuide, Nobuo Toda, Iruru Maetani, Yuji Sakai, Takao Itoi, Masatsugu Nagahama, Yousuke Nakai, Hiroyuki Isayama
Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan
Tsuyoshi Hamada, Yousuke Nakai, Hiroyuki Isayama, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
Osamu Togawa, Department of Gastroenterology, Saitama International Medical Center, Saitama Medical University, Saitama 350-1298, Japan
Ryuichi Yamamoto, Department of Gastroenterology and Hepatology, Saitama Medical University International Medical Center, Saitama 350-8550, Japan
Tomohisa Iwai, Department of Gastroenterology, Kitasato University, Kanagawa 252-0375, Japan
Kiichi Tamada, Department of Gastroenterology, Jichi Medical University, Tochigi 329-0498, Japan
Yoshiaki Kawaguchi, Department of Gastroenterology, Tokai University, Kanagawa 259-1193, Japan
Kenji Shimura, Department of Gastroenterology, Asahi General Hospital, Chiba 289-2511, Japan
Takero Koike, Department of Internal Medicine, Japanese Red Cross Ashikaga Hospital, Tochigi 326-0843, Japan
Yu Yoshida, Department of Gastroenterology, Kimitsu Central Hospital, Chiba 292-8535, Japan
Kazuya Sugimori, Department of Gastroenterology, Yokohama City University Medical Center, Kanagawa 232-0024, Japan
Shomei Ryozawa, Department of Gastroenterology, Showa University Northern Yokohama Hospital, Kanagawa 242-0032, Japan
Toshiharu Kakimoto, Department of Gastroenterology, Saitama City Hospital, Saitama 336-8522, Japan
Ko Nishikawa, Department of Gastroenterology, Ageo Central General Hospital, Saitama 362-8588, Japan
Katsuya Kitamura, Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan
Tsunao Imamura, Department of Gastroenterology, Toranomon Hospital, Tokyo 105-0001, Japan
Masafumi Mizuide, Department of Gastroenterology, Gunma University, Gunma 371-0034, Japan
Nobuo Toda, Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo 101-8643, Japan
Iruru Maetani, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo 153-0044, Japan
Yuji Sakai, Department of Gastroenterology, Chiba University, Chiba 260-0856, Japan
Takao Itoi, Department of Gastroenterology, Tokyo Medical University, Tokyo 160-0023, Japan
Masatsugu Nagahama, Department of Gastroenterology, Showa University Fujigaoka Hospital, Kanagawa 227-8501, Japan
Author contributions: Sasahira N, Tamada K, Kawaguchi Y, Shimura K, Sugimori K, Kakimoto T, Mizuide M, Maetani I, Sakai Y, Itoi T, Nagahama M and Isayama H designed the research; Sasahira N, Hamada T, Togawa O, Yamamoto R, Iwai T, Tamada K, Kawaguchi Y, Shimura K, Koike T, Yoshida Y, Sugimori K, Ryozawa S, Kakimoto T, Nishikawa K, Kitamura K, Imamura T, Mizuide M, Toda N, Maetani I, Sakai Y, Itoi T and Nagahama M acquired the data; Sasahira N and Hamada T analyzed the data; Sasahira N, Hamada T and Nakai Y wrote the paper; Tamada K, Ryozawa S, Maetani I, Itoi T and Isayama H revised the manuscript critically for important intellectual content; Isayama H finally approved the article.
Supported by The grant from the Japanese Foundation for Research and Promotion of Endoscopy, No. 12-042.
Institutional review board statement: The study was reviewed and approved by the ethics committee at The University of Tokyo Hospital and at each participating hospital.
Informed consent statement: Informed consent was not obtained from each participant because this was the retrospective study and all participants had completed the observation period at the initiation of the study. Instead of that, all participants were given the right to withdraw the use of the data. Both were approved by the institutional review board of each hospital.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hiroyuki Isayama, MD, PhD, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan. isayama-tky@umin.ac.jp
Telephone: +81-3-38155411 Fax: +81-3-38140021
Received: November 19, 2015
Peer-review started: November 23, 2015
First decision: December 11, 2015
Revised: January 3, 2016
Accepted: January 30, 2016
Article in press: January 30, 2016
Published online: April 14, 2016
Abstract

AIM: To determine the optimal method of endoscopic preoperative biliary drainage for malignant distal biliary obstruction.

METHODS: Multicenter retrospective study was conducted in patients who underwent plastic stent (PS) or nasobiliary catheter (NBC) placement for resectable malignant distal biliary obstruction followed by surgery between January 2010 and March 2012. Procedure-related adverse events, stent/catheter dysfunction (occlusion or migration of PS/NBC, development of cholangitis, or other conditions that required repeat endoscopic biliary intervention), and jaundice resolution (bilirubin level < 3.0 mg/dL) were evaluated. Cumulative incidence of jaundice resolution and dysfunction of PS/NBC were estimated using competing risk analysis. Patient characteristics and preoperative biliary drainage were also evaluated for association with the time to jaundice resolution and PS/NBC dysfunction using competing risk regression analysis.

RESULTS: In total, 419 patients were included in the study (PS, 253 and NBC, 166). Primary cancers included pancreatic cancer in 194 patients (46%), bile duct cancer in 172 (41%), gallbladder cancer in three (1%), and ampullary cancer in 50 (12%). The median serum total bilirubin was 7.8 mg/dL and 324 patients (77%) had ≥ 3.0 mg/dL. During the median time to surgery of 29 d [interquartile range (IQR), 30-39 d]. PS/NBC dysfunction rate was 35% for PS and 18% for NBC [Subdistribution hazard ratio (SHR) = 4.76; 95%CI: 2.44-10.0, P < 0.001]; the pig-tailed tip was a risk factor for PS dysfunction. Jaundice resolution was achieved in 85% of patients and did not depend on the drainage method (PS or NBC).

CONCLUSION: PS has insufficient patency for preoperative biliary drainage. Given the drawbacks of external drainage via NBC, an alternative method of internal drainage should be explored.

Keywords: Endoscopic preoperative biliary drainage, Malignant distal biliary obstruction, Periampullary cancer, Plastic stent, Nasobiliary drainage

Core tip: To determine the optimal method of endoscopic preoperative biliary drainage for malignant distal biliary obstruction, we conducted a multicenter retrospective study in 419 patients who underwent plastic stent (PS) or nasobiliary catheter (NBC) placement for resectable malignant distal biliary obstruction followed by surgery. The dysfunction rate for PS was significantly higher than that for NBC. Since the current limitations of nasobiliary catheter may not be overcome by a plastic stent, further studies may need to focus on the use of other stents that could remain patent for a longer period of time.