Prospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2023; 15(4): 698-711
Published online Apr 27, 2023. doi: 10.4240/wjgs.v15.i4.698
Effectiveness of a new approach to minimally invasive surgery in palliative treatment of patients with distal malignant biliary obstruction
Yaroslav M Susak, Leonid L Markulan, Serhii M Lobanov, Roman Y Palitsya, Mariia P Rudyk, Larysa M Skivka
Yaroslav M Susak, Leonid L Markulan, Serhii M Lobanov, Department of Surgery with the Course of Emergency and Vascular Surgery, O.O. Bogomolets National Medical University, Kyiv 01601, Ukraine
Roman Y Palitsya, Department of Abdominal Surgery, National Military Medical Clinical Centre “Main Military Clinical Hospital”, Kyiv 01133, Ukraine
Mariia P Rudyk, Larysa M Skivka, Department of Microbiology and Immunology, Taras Shevchenko National University of Kyiv, Kyiv 01033, Ukraine
Author contributions: Susak YM participated in the design of the study and supervised its implementation; Markulan LL participated in the study as a chief surgeon and performed surgical procedures; Palitsya RY assisted in surgical procedures; Rudyk MP contributed to data collection and participated in statistical analysis; Skivka LM participated in the design of the study, carried out statistical analysis, and wrote the draft.
Institutional review board statement: The study was reviewed and approved by the Committee on Human Rights Related to Research Involving Human Subjects of Kyiv City Clinical Emergency Hospital (Kyiv, Ukraine) (Approval No. 25-15-65).
Clinical trial registration statement: This study is registered at https://nddkr.ukrintei.ua/view/rk/67a7ff7c333c5bb067a8c3902353ec74, and the registration identification number is 0121U108878.
Informed consent statement: All subjects gave their written informed consent prior to study inclusion.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mariia P Rudyk, PhD, Associate Professor, Department of Microbiology and Immunology, Taras Shevchenko National University of Kyiv, 60 Volodymyrska St, Kyiv 01033, Ukraine. rosiente@gmail.com
Received: November 17, 2022
Peer-review started: November 17, 2022
First decision: January 23, 2023
Revised: February 5, 2023
Accepted: March 3, 2023
Article in press: March 3, 2023
Published online: April 27, 2023
Abstract
BACKGROUND

Palliative endoscopic biliary drainage is the primary treatment option for the management of patients with jaundice which results from distal malignant biliary obstruction (DMBO). In this group of patients, decompression of the bile duct (BD) allows for pain reduction, symptom relief, chemotherapy administration, improved quality of life, and increased survival rate. To reduce the unfavorable effects of BD decompression, minimally invasive surgical techniques require continuous improvement.

AIM

To develop a technique for internal-external biliary-jejunal drainage (IEBJD) and assess its effectiveness in comparison to other minimally invasive procedures in the palliative treatment of patients with DMBO.

METHODS

A retrospective analysis of prospectively collected data was performed, which included 134 patients with DMBO who underwent palliative BD decompression. Biliary-jejunal drainage was developed to divert bile from the BD directly into the initial loops of the small intestine to prevent duodeno-biliary reflux. IEBJD was carried out using percutaneous transhepatic access. Percutaneous transhepatic biliary drainage (PTBD), endoscopic retrograde biliary stenting (ERBS), and internal-external transpapillary biliary drainage (IETBD) were used for the treatment of study patients. Endpoints of the study were the clinical success of the procedure, the frequency and nature of complications, and the cumulative survival rate.

RESULTS

There were no significant differences in the frequency of minor complications between the study groups. Significant complications occurred in 5 (17.2%) patients in the IEBJD group, in 16 (64.0%) in the ERBS group, in 9 (47.4%) in the IETBD group, and in 12 (17.4%) in the PTBD group. Cholangitis was the most common severe complication. In the IEBJD group, the course of cholangitis was characterized by a delayed onset and shorter duration as compared to other study groups. The cumulative survival rate of patients who underwent IEBJD was 2.6 times higher in comparison to those of the PTBD and IETBD groups and 20% higher in comparison to that of the ERBS group.

CONCLUSION

IEBJD has advantages over other minimally invasive BD decompression techniques and can be recommended for the palliative treatment of patients with DMBO.

Keywords: Distal malignant biliary obstruction, Obstructive jaundice, Bile duct decompression, Palliative endoscopic biliary drainage, Internal-external biliary-jejunal drainage

Core Tip: This study compared the new technique of internal-external biliary-jejunal drainage (IEBJD) for bile duct (BD) decompression in patients with obstructive jaundice with commonly used procedures through a retrospective analysis of prospectively collected data. IEBJD was used to divert bile from the BD directly into the initial loops of the small intestine to prevent duodeno-biliary reflux. The application of IEBJD was associated with a decreased incidence of significant complications, a delayed onset of cholangitis and its shorter duration, as well as an increased cumulative survival rate in patients with distal malignant biliary obstruction as compared to commonly used endoscopic ultrasound-guided retrograde and antegrade techniques and internal-external transpapillary biliary drainage.