Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(08): E1020-E1030
DOI: 10.1055/a-0614-2202
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

Effectiveness of a modified 6-Fr endoscopic nasobiliary drainage catheter for patients with preoperative perihilar cholangiocarcinoma

Hiroki Kawashima
1   Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,
Yoshiki Hirooka
2   Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
,
Eizaburo Ohno
1   Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,
Takuya Ishikawa
1   Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,
Ryoji Miyahara
1   Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,
Osamu Watanabe
1   Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,
Kazuhiko Hayashi
1   Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,
Masatoshi Ishigami
1   Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,
Senju Hashimoto
3   Department of Liver, Biliary Tract and Pancreas Diseases, Fujita Health University Hospital, Toyoake, Japan
,
Tomoki Ebata
4   Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
,
Masato Nagino
4   Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
,
Hidemi Goto
1   Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
› Author AffiliationsTRIAL REGISTRATION: Retrospective study of clinical utility of Endoscopic Retrograde Cholangiopancreatography and relative for digestive diseases. UMIN-CTR (UMIN000025631)
Further Information

Publication History

submitted 09 January 2018

accepted after revision 12 April 2018

Publication Date:
10 August 2018 (online)

Also available at
   Permissions and Reprints

Abstract

Background and study aims To decrease complications associated with preoperative endoscopic nasobiliary drainage (ENBD) for perihilar cholangiocarcinoma patients, we developed a modified 6-Fr ENBD catheter with multiple side holes (m-ENBD). The aim of this retrospective study was to compare the m-ENBD catheter with a conventional 7-Fr ENBD catheter (c-ENBD).

Patients and methods This study involved 371 patients with suspected perihilar cholangiocarcinoma who underwent ENBD using a c-ENBD catheter or an m-ENBD catheter. The effectiveness of each catheter and the incidence of complications were evaluated. Univariate and multivariate analyses followed by propensity score matching were performed.

Results In 145 patients with total bilirubin levels ≥ 2.0 mg/dL prior to drainage, these levels decreased to < 2.0 mg/dL after ENBD in 81.1 % of the c-ENBD patients and in 74.0 % of the m-ENBD patients (P = 0.325). Post-ENBD cholangitis occurred in 24.9 % of the c-ENBD patients and in 12.4 % of the m-ENBD patients (P = 0.006). After propensity score matching, the rate of post-ENBD cholangitis (P = 0.007) and the number of patients requiring subsequent or additional drainage (P = 0.030) were significantly lower in the m-ENBD group.

Conclusion The modified 6-Fr ENBD catheter was associated with a lower incidence of post-ENBD cholangitis than the conventional 7-Fr ENBD catheter, and the incidence of subsequent or additional drainage procedures was also decreased.

 

  • References

  • 1 Nagino M, Nimura Y, Kamiya J. et al. Preoperative management of hilar cholangiocarcinoma. J Hepatobiliary Pancreat Surg 1995; 2: 215-223
    CrossrefPubMedSearch in Google Scholar
  • 2 Nimura Y, Kamiya J, Kondo S. et al. Aggressive preoperative management and extended surgery for hila cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg 2000; 7: 155-162
    CrossrefPubMedSearch in Google Scholar
  • 3 Nagino M, Takada T, Miyazaki M. et al. Preoperative biliary drainage for biliary tract and ampullary carcinomas. J Hepatobiliary Pancreat Surg 2008; 15: 25-30
    CrossrefPubMedSearch in Google Scholar
  • 4 Nagino M, Kamiya J, Nishio H. et al. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer surgical outcome and long-term follow-up. Ann Surg 2006; 243: 364-372
    CrossrefPubMedSearch in Google Scholar
  • 5 Kawashima H, Itoh A, Ohno E. et al. Preoperative endoscopic nasobiliary drainage in 164 consecutive patients with suspected perihilar cholangiocarcinoma: a retrospective study of efficacy and risk factors related to complications. Ann Surg 2013; 257: 121-127
    CrossrefPubMedSearch in Google Scholar
  • 6 Kloek JJ, van der Gaag NA, Aziz Y. et al. Endoscopic and percutaneous preoperative biliary drainage in patients with suspected hilar cholangiocarcinoma. J Gastrointest Surg 2010; 14: 119-125
    CrossrefPubMedSearch in Google Scholar
  • 7 Takahashi Y, Nagino M, Nishio H. et al. Percutaneous transhepatic biliary drainage catheter tract recurrence in cholangiocarcinoma. Br J Surg 2010; 97: 1860-1866
    CrossrefPubMedSearch in Google Scholar
  • 8 Komaya K, Ebata T, Fukami Y. et al. Percutaneous biliary drainage is oncologically inferior to endoscopic drainage: a propensity score matching analysis in resectable distal cholangiocarcinoma. J Gastroenterol 2016; 51: 608-619
    CrossrefPubMedSearch in Google Scholar
  • 9 Komaya K, Ebata T, Yokoyama Y. et al. Verification of the oncologic inferiority of percutaneous biliary drainage to endoscopic drainage: A propensity score matching analysis of resectable perihilar cholangiocarcinoma. Surgery 2017; 161: 394-404
    CrossrefPubMedSearch in Google Scholar
  • 10 Maguchi H, Takahashi K, Katanuma A. et al. Preoperative biliary drainage for hilar cholangiocarcinoma. J Hepatobiliary Pancreat Surg 2007; 14: 441-446
    CrossrefPubMedSearch in Google Scholar
  • 11 Arakura N, Takayama M, Ozaki Y. et al. Efficacy of preoperative endoscopic nasobiliary drainage for hilar cholangiocarcinoma. J Hepatobiliary Pancreat Surg 2009; 16: 473-477
    CrossrefPubMedSearch in Google Scholar
  • 12 Kawakami H, Kuwatani M, Onodera M. et al. Endoscopic nasobiliary drainage is the most suitable preoperative biliary drainage method in the management of patients with hilar cholangiocarcinoma. J Gastroenterol 2011; 46: 242-248
    CrossrefPubMedSearch in Google Scholar
  • 13 Ishigaki T, Sasaki T, Serikawa M. et al. Comparative study of 4 Fr versus 6 Fr nasobiliary drainage catheters: a randomized, controlled trial. J Gastroenterol Hepatol 2014; 29: 653-659
    CrossrefPubMedSearch in Google Scholar
  • 14 Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet 1975; 140: 170-176
    PubMedSearch in Google Scholar
  • 15 Sugiura T, Nishio H, Nagino M. et al. Value of multidetector-row computed tomography in diagnosis of portal vein invasion by perihilar cholangiocarcinoma. World J Surg 2008; 32: 1478-1484
    CrossrefPubMedSearch in Google Scholar
  • 16 Senda Y, Nishio H, Oda K. et al. Value of multidetector row CT in the assessment of longitudinal extension of cholangiocarcinoma – correlation between MDCT and microscopic findings. World J Surg 2009; 33: 1459-1467
    CrossrefPubMedSearch in Google Scholar
  • 17 Kawashima H, Hirooka Y, Itoh A. et al. Progress of endoscopic ultrasonography and intraductal ultrasonography in the diagnosis of malignant biliary diseases. J Hepatobiliary Pancreat Surg 2006; 13: 69-74
    CrossrefPubMedSearch in Google Scholar
  • 18 Kawashima H, Itoh A, Ohno E. et al. Diagnostic and prognostic value of immunohistochemical expression of S100P and IMP3 in transpapillary biliary forceps biopsy samples of extrahepatic bile duct carcinoma. J Hepatobiliary Pancreat Sci 2013; 20: 441-447
    CrossrefPubMedSearch in Google Scholar
  • 19 Natsume S, Ebata T, Yokoyama Y. et al. Clinical significance of left trisectionectomy for perihilar cholangiocarcinoma: An appraisal and complication with left hepatectomy. Ann Surg 2012; 255: 754-762
    CrossrefPubMedSearch in Google Scholar
  • 20 Kamiya S, Nagino M, Kanazawa H. et al. The value of bile replacement during external biliary drainage: an analysis of intestinal permeability, integrity, and microflora. Ann Surg 2004; 239: 510-517
    CrossrefPubMedSearch in Google Scholar
  • 21 Kiriyama S, Takada T, Strasberg SM. et al. New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo guidelines. J Hepatobiliary Pancreat Sci 2012; 19: 548-556
    CrossrefPubMedSearch in Google Scholar
  • 22 Banks PA, Bollen TL, Dervenis C. et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62: 102-111
    CrossrefPubMedSearch in Google Scholar
  • 23 Rosenbaum PR. Model-based direct adjustment. J AM Stat Assoc 1987; 82: 387-394
    CrossrefPubMedSearch in Google Scholar
  • 24 Rubin DB. Estimating causal effects from large data sets using propensity scores. Ann Intern Med 1997; 127: 757-763
    CrossrefPubMedSearch in Google Scholar
  • 25 Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 2011; 46: 399-424
    CrossrefPubMedSearch in Google Scholar
  • 26 Igami T, Nishio H, Ebata T. et al. Surgical treatment of hilar cholangiocarcinoma in the “new era”: the Nagoya University experience. J Hepatobiliary Pancreat Sci 2010; 17: 449-454
    CrossrefPubMedSearch in Google Scholar
  • 27 Ebata T, Yokoyama Y, Igami T. et al. Hepatopancreatoduodenectomy for cholangiocarcinoma: a single-center review of 85 consecutive patients. Ann Surg 2012; 256: 297-305
    CrossrefPubMedSearch in Google Scholar
  • 28 Ebata T, Yokoyama Y, Igami T. et al. Portal vein embolization before extended hepatectomy for biliary cancer: current technique and review of 494 consecutive embolizations. Dig Surg 2012; 29: 23-29
    CrossrefPubMedSearch in Google Scholar
  • 29 Fujisawa T, Kagawa K, Watanabe S. et al. Endoscopic nasobiliary drainage for obstructive jaundice using either a 5 Fr or 7 Fr catheter: a prospective, randomized trial. BMC Gastroenterol 2014; 14: 161
    CrossrefPubMedSearch in Google Scholar
  • 30 Nagino M, Nimura Y, Hayakawa N. et al. Logistic regression and discriminant analyses of hepatic failure after liver resection for carcinoma of the biliary tract. World J Surg 1993; 17: 250-255
    CrossrefPubMedSearch in Google Scholar