EVALUATION OF PREDICTORS FACTORS OF FAILURE IN ENDOSCOPIC BILIARY DRAINAGE IN MALIGNANT HILAR BILIARY STRICTURE

Aims:

To evaluate the clinical success of biliary drainage by ERCP in patients with primary or secondary malignant hilar biliary stricture and to analyze the predictors factors of failure.

Methods:

This is a retrospective, observational study, in a tertiary oncologic center in Brazil. We included all the patients with malignant hilar biliary stricture (Bismuth ≥ II) submitted to a biliary drainage by ERCP, between January 2010 and December 2017. Clinical success was defined as a decrease in the direct bilirubin level to ≤50% of the pretreatment value within 2 weeks.

Results:

82 patients were included. Bismuth classification grades II, IIIA, IIIB, and IV were noted in 23.2%, 15.9%, 14.6% and 46.3%, respectively. The indication of ERCP was palliative drainage in 56.1%, cholangitis in 29.3% and in previous stent obstruction in 13.4%. About 39% of the patients had a previous stent, 35.4% had plastic stent and 3.7% had metallic stent. The mean direct bilirubin was 8.2 mg/dL.

In 7.3% stent placement technically failed. In 20.7% one hepatic lobe was drainage, in 64.6% more than one lobe was drainage and in 7.3 the stent was placed distal to the confluence of the biliary hepatic branch. The clinical success rate was 53.7%.

The strictures Bismuth IV were related with lower clinical success rate when compared with others strictures (Table 1).

Tab. 1:

Predictors of clinical failure for biliary stents

Model and variable	B (S.E)	Hazard ratio (95% CI)	P value
Biliary strictures Bismuth IV	1.65 (0.71)	5.18 (1.28 – 20.88)	0.021
Lobes > 1 lobe	0.84 (0.67)	2.31 (0.62 – 8.59)	0.213
Cholangitis Presence	1.42 (0.85)	4.15 (0.78 – 22.04)	0.095
Bilirubin levels	0.07 (0.04)	1.07 (0.99 – 1.15)	0.052

Conclusions:

Endoscopic biliary drainage for malignant hilar biliary stricture still has limited clinical success rate. The proximal strictures (Bismuth IV) are associated with lower clinical success rate.