Multidisciplinary Approach to Malignant Biliary Obstruction

Abstract

Treatment of malignant biliary obstruction (MBO) requires the coordination of multiple specialties, including oncologists, surgeons, gastroenterologists, and interventional radiologists. If the tumor is resectable, surgical candidates can usually proceed to surgery without preoperative biliary drainage. For patients who undergo biliary drainage, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) combined with biliary stenting are techniques with comparable technical success and mortality, each with distinct advantages and risks. Advances in endoscopic ultrasound allow drainage in patients with challenging anatomy. There are a multitude of devices used for biliary decompression. Self-expanding metal stents (SEMS), with longer patency rates, are in most instances preferred over plastic stents for MBO, especially in patients with life expectancy more than 3 to 4 months. Advantages of covered SEMS versus uncovered SEMS remain controversial as covered stents can prevent tumor ingrowth but at the expense of potential increase in stent migrations. Extra-anatomic biliary drainage using lumen-apposing metal stents is an emerging technique which shows promise when conventional ERCP fails. It is imperative to understand these techniques when tailoring a treatment strategy. The goal of this article is to discuss a multidisciplinary approach for MBO to promote comprehensive care using case examples to highlight essential principles.

Keywords

malignant biliary obstruction - percutaneous transhepatic cholangiography - endoscopic retrograde cholangiopancreaography - biliary stents

Publikationsverlauf

Eingereicht: 04. Juni 2020

Angenommen: 30. Juli 2020

Artikel online veröffentlicht:
22. September 2020

• References

• 1 Boulay BR, Birg A. Malignant biliary obstruction: from palliation to treatment. World J Gastrointest Oncol 2016; 8 (06) 498-508
• 2 Iacono C, Ruzzenente A, Campagnaro T, Bortolasi L, Valdegamberi A, Guglielmi A. Role of preoperative biliary drainage in jaundiced patients who are candidates for pancreatoduodenectomy or hepatic resection: highlights and drawbacks. Ann Surg 2013; 257 (02) 191-204
• 3 van der Gaag NA, Rauws EA, van Eijck CH. et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med 2010; 362 (02) 129-137
• 4 Kim JH. Endoscopic stent placement in the palliation of malignant biliary obstruction. Clin Endosc 2011; 44 (02) 76-86
• 5 Albores-Saavedra J, Schwartz AM, Batich K, Henson DE. Cancers of the ampulla of vater: demographics, morphology, and survival based on 5,625 cases from the SEER program. J Surg Oncol 2009; 100 (07) 598-605
• 6 Ryan DP, Hong TS, Bardeesy N. Pancreatic adenocarcinoma. N Engl J Med 2014; 371 (11) 1039-1049
• 7 Rege RV. Adverse effects of biliary obstruction: implications for treatment of patients with obstructive jaundice. AJR Am J Roentgenol 1995; 164 (02) 287-293
• 8 Viesca MFY, Arvanitakis M. Early diagnosis and management of malignant distal biliary obstruction: a review on current recommendations and guidelines. Clin Exp Gastroenterol 2019; 12: 415-432
• 9 Levy JL, Sudheendra D, Dagli M. et al. Percutaneous biliary drainage effectively lowers serum bilirubin to permit chemotherapy treatment. Abdom Radiol (NY) 2016; 41 (02) 317-323
• 10 Namias N, Demoya M, Sleeman D. et al. Risk of postoperative infection in patients with bactibilia undergoing surgery for obstructive jaundice. Surg Infect (Larchmt) 2005; 6 (03) 323-328
• 11 Kennedy TJ, Yopp A, Qin Y. et al. Role of preoperative biliary drainage of liver remnant prior to extended liver resection for hilar cholangiocarcinoma. HPB (Oxford) 2009; 11 (05) 445-451
• 12 Moole H, Bechtold M, Puli SR. Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review. World J Surg Oncol 2016; 14 (01) 182
• 13 Heinrich S, Lang H. Neoadjuvant therapy of pancreatic cancer: definitions and benefits. Int J Mol Sci 2017; 18 (08) E1622
• 14 Fidias P, Carey RW, Grossbard ML. Non-Hodgkin's lymphoma presenting with biliary tract obstruction. A discussion of seven patients and a review of the literature. Cancer 1995; 75 (07) 1669-1677
• 15 Ghosh I, Bakhshi S. Jaundice as a presenting manifestation of pediatric non-Hodgkin lymphoma: etiology, management, and outcome. J Pediatr Hematol Oncol 2010; 32 (04) e131-e135
• 16 Khashab MA, Chithadi KV, Acosta RD. ASGE Standards of Practice Committee. et al. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc 2015; 81 (01) 81-89
• 17 Krutsri C, Kida M, Yamauchi H, Iwai T, Imaizumi H, Koizumi W. Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy. World J Gastroenterol 2019; 25 (26) 3313-3333
• 18 Szary NM, Al-Kawas FH. Complications of endoscopic retrograde cholangiopancreatography: how to avoid and manage them. Gastroenterol Hepatol (N Y) 2013; 9 (08) 496-504
• 19 Pekgöz M. Post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review for prevention and treatment. World J Gastroenterol 2019; 25 (29) 4019-4042
• 20 Chandrashekhara SH, Gamanagatti S, Singh A, Bhatnagar S. Current status of percutaneous transhepatic biliary drainage in palliation of malignant obstructive jaundice: a review. Indian J Palliat Care 2016; 22 (04) 378-387
• 21 Chehab MA, Thakor AS, Tulin-Silver S. et al. Adult and pediatric antibiotic prophylaxis during vascular and IR procedures: a Society of Interventional Radiology Practice Parameter Update Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology. J Vasc Interv Radiol 2018; 29 (11) 1483-1501.e2
• 22 Young M, Mehta D. Percutaneous Transhepatic Cholangiogram. Treasure Island, FL: StatPearls; 2020
• 23 Saad WE, Wallace MJ, Wojak JC, Kundu S, Cardella JF. Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy. J Vasc Interv Radiol 2010; 21 (06) 789-795
• 24 Quencer KB, Tadros AS, Marashi KB. et al. Bleeding after percutaneous transhepatic biliary drainage: incidence, causes and treatments. J Clin Med 2018; 7 (05) E94
• 25 Mohamadnejad M, DeWitt JM, Sherman S. et al. Role of EUS for preoperative evaluation of cholangiocarcinoma: a large single-center experience. Gastrointest Endosc 2011; 73 (01) 71-78
• 26 Mishra A, Tyberg A. Endoscopic ultrasound guided biliary drainage: a comprehensive review. Transl Gastroenterol Hepatol 2019; 4: 10
• 27 Wang K, Zhu J, Xing L, Wang Y, Jin Z, Li Z. Assessment of efficacy and safety of EUS-guided biliary drainage: a systematic review. Gastrointest Endosc 2016; 83 (06) 1218-1227
• 28 Navaneethan U, Njei B, Lourdusamy V, Konjeti R, Vargo JJ, Parsi MA. Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis. Gastrointest Endosc 2015; 81 (01) 168-176
• 29 Lee SJ, Lee YS, Lee MG, Lee SH, Shin E, Hwang JH. Triple-tissue sampling during endoscopic retrograde cholangiopancreatography increases the overall diagnostic sensitivity for cholangiocarcinoma. Gut Liver 2014; 8 (06) 669-673
• 30 Sadeghi A, Mohamadnejad M, Islami F. et al. Diagnostic yield of EUS-guided FNA for malignant biliary stricture: a systematic review and meta-analysis. Gastrointest Endosc 2016; 83 (02) 290-8.e1
• 31 Wu LM, Jiang XX, Gu HY. et al. Endoscopic ultrasound-guided fine-needle aspiration biopsy in the evaluation of bile duct strictures and gallbladder masses: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2011; 23 (02) 113-120
• 32 Weilert F, Bhat YM, Binmoeller KF. et al. EUS-FNA is superior to ERCP-based tissue sampling in suspected malignant biliary obstruction: results of a prospective, single-blind, comparative study. Gastrointest Endosc 2014; 80 (01) 97-104
• 33 Heimbach JK, Sanchez W, Rosen CB, Gores GJ. Trans-peritoneal fine needle aspiration biopsy of hilar cholangiocarcinoma is associated with disease dissemination. HPB (Oxford) 2011; 13 (05) 356-360
• 34 Schwartz JJ, Thiesset HF, Clayton F, Adler DG, Hutson WR, Carlisle JG. Using the modern Silverhawk™ atherectomy catheter to characterize biliary structures that appear malignant: review of initial experience. HPB (Oxford) 2011; 13 (11) 823-829
• 35 Siddiqui AA, Mehendiratta V, Jackson W, Loren DE, Kowalski TE, Eloubeidi MA. Identification of cholangiocarcinoma by using the Spyglass Spyscope system for peroral cholangioscopy and biopsy collection. Clin Gastroenterol Hepatol 2012; 10 (05) 466-471 , quiz e48
• 36 Yang JF, Sharaiha RZ, Francis G. et al. Diagnostic accuracy of directed cholangioscopic biopsies and confocal laser endomicroscopy in cytology-negative indeterminate bile duct stricture: a multicenter comparison trial. Minerva Gastroenterol Dietol 2016; 62 (03) 227-233
• 37 Pfau PR, Pleskow DK, Banerjee S. ASGE Technology Assessment Committee. et al. Pancreatic and biliary stents. Gastrointest Endosc 2013; 77 (03) 319-327
• 38 Dumonceau JM, Tringali A, Papanikolaou IS. et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline - Updated October 2017. Endoscopy 2018; 50 (09) 910-930
• 39 Donelli G, Guaglianone E, Di Rosa R, Fiocca F, Basoli A. Plastic biliary stent occlusion: factors involved and possible preventive approaches. Clin Med Res 2007; 5 (01) 53-60
• 40 Almadi MA, Barkun A, Martel M. Plastic vs. self-expandable metal stents for palliation in malignant biliary obstruction: a series of meta-analyses. Am J Gastroenterol 2017; 112 (02) 260-273
• 41 Barkun AN, Adam V, Martel M, AlNaamani K, Moses PL. Partially covered self-expandable metal stents versus polyethylene stents for malignant biliary obstruction: a cost-effectiveness analysis. Can J Gastroenterol Hepatol 2015; 29 (07) 377-383
• 42 Gardner TB, Spangler CC, Byanova KL. et al. Cost-effectiveness and clinical efficacy of biliary stents in patients undergoing neoadjuvant therapy for pancreatic adenocarcinoma in a randomized controlled trial. Gastrointest Endosc 2016; 84 (03) 460-466
• 43 Crippa S, Cirocchi R, Partelli S. et al. Systematic review and meta-analysis of metal versus plastic stents for preoperative biliary drainage in resectable periampullary or pancreatic head tumors. Eur J Surg Oncol 2016; 42 (09) 1278-1285
• 44 Song TJ, Lee JH, Lee SS. et al. Metal versus plastic stents for drainage of malignant biliary obstruction before primary surgical resection. Gastrointest Endosc 2016; 84 (05) 814-821
• 45 Tol JA, van Hooft JE, Timmer R. et al. Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer. Gut 2016; 65 (12) 1981-1987
• 46 Tsuboi T, Sasaki T, Serikawa M. et al. Preoperative biliary drainage in cases of borderline resectable pancreatic cancer treated with neoadjuvant chemotherapy and surgery. Gastroenterol Res Pract 2016; 2016: 7968201
• 47 Kuwatani M, Nakamura T, Hayashi T. Hokkaido Pancreatic Cancer Study Group (HOPS). et al. Clinical outcomes of biliary drainage during a neoadjuvant therapy for pancreatic cancer: metal versus plastic stents. Gut Liver 2020; 14 (02) 269-273
• 48 Moole H, Bechtold ML, Cashman M. et al. Covered versus uncovered self-expandable metal stents for malignant biliary strictures: a meta-analysis and systematic review. Indian J Gastroenterol 2016; 35 (05) 323-330
• 49 Chen MY, Lin JW, Zhu HP. et al. Covered stents versus uncovered stents for unresectable malignant biliary strictures: a meta-analysis. BioMed Res Int 2016; 2016: 6408067
• 50 Tringali A, Hassan C, Rota M, Rossi M, Mutignani M, Aabakken L. Covered vs. uncovered self-expandable metal stents for malignant distal biliary strictures: a systematic review and meta-analysis. Endoscopy 2018; 50 (06) 631-641
• 51 Li J, Li T, Sun P. et al. Covered versus uncovered self-expandable metal stents for managing malignant distal biliary obstruction: a meta-analysis. PLoS One 2016; 11 (02) e0149066
• 52 Kadah A, Khoury T, Mari A, Mahamid M, Sbeit W. Lumen-apposing metal stents in interventional endoscopy: a state-of-the-art review with focus on technical and clinical successes and complications. Eur J Gastroenterol Hepatol 2020; 32 (01) 1-9
• 53 Jacques J, Privat J, Pinard F. et al. EUS-guided choledochoduodenostomy by use of electrocautery-enhanced lumen-apposing metal stents: a French multicenter study after implementation of the technique (with video). Gastrointest Endosc 2020; 92 (01) 134-141
• 54 Anderloni A, Fugazza A, Troncone E. et al. Single-stage EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction. Gastrointest Endosc 2019; 89 (01) 69-76
• 55 Anderloni A, Troncone E, Fugazza A. et al. Lumen-apposing metal stents for malignant biliary obstruction: Is this the ultimate horizon of our experience?. World J Gastroenterol 2019; 25 (29) 3857-3869
• 56 Luo J, Yan Z, Liu Q, Qu X, Wang J. Endovascular placement of iodine-125 seed strand and stent combined with chemoembolization for treatment of hepatocellular carcinoma with tumor thrombus in main portal vein. J Vasc Interv Radiol 2011; 22 (04) 479-489
• 57 Li W, Dai Z, Yao L, Luo J, Yan Z. Chemoembolization and stenting combined with iodine-125 seed strands for the treatment of hepatocellular carcinoma with inferior vena cava obstruction. Exp Ther Med 2015; 10 (03) 973-977
• 58 Hasimu A, Gu JP, Ji WZ, Zhang HX, Zhu DW, Ren WX. Comparative study of percutaneous transhepatic biliary stent placement with or without iodine-125 seeds for treating patients with malignant biliary obstruction. J Vasc Interv Radiol 2017; 28 (04) 583-593
• 59 Zhu HD, Guo JH, Huang M. et al. Irradiation stents vs. conventional metal stents for unresectable malignant biliary obstruction: a multicenter trial. J Hepatol 2018; 68 (05) 970-977
• 60 Pang Q, Zhou L, Hu XS. et al. Biliary stenting alone versus biliary stenting combined with ¹²⁵I particles intracavitary irradiation for the treatment of advanced cholangiocarcinoma. Sci Rep 2019; 9 (01) 11348
• 61 Jang SI, Lee SJ, Jeong S. et al. Efficacy of a multiplex paclitaxel emission stent using a Pluronic^® mixture membrane versus a covered metal stent in malignant biliary obstruction: a prospective randomized comparative study. Gut Liver 2017; 11 (04) 567-573
• 62 Green C, Brown KT, Erinjeri JP. et al. Does stent placement across the ampulla of vater increase the risk of subsequent cholangitis?. J Vasc Interv Radiol 2014; 25 (03) S49
• 63 Renno A, Abdel-Aziz Y, Ahmed T. et al. Antireflux valve metal stent versus conventional self-expandable metal stent in distal malignant biliary obstruction: a systematic review and meta-analysis. Ann Gastroenterol 2019; 32 (06) 605-613
• 64 Moole H, Tathireddy H, Dharmapuri S. et al. Success of photodynamic therapy in palliating patients with nonresectable cholangiocarcinoma: a systematic review and meta-analysis. World J Gastroenterol 2017; 23 (07) 1278-1288
• 65 Leggett CL, Gorospe EC, Murad MH, Montori VM, Baron TH, Wang KK. Photodynamic therapy for unresectable cholangiocarcinoma: a comparative effectiveness systematic review and meta-analyses. Photodiagn Photodyn Ther 2012; 9 (03) 189-195
• 66 Wang J, Zhao L, Zhou C. et al. Percutaneous intraductal radiofrequency ablation combined with biliary stent placement for nonresectable malignant biliary obstruction improves stent patency but not survival. Medicine (Baltimore) 2016; 95 (15) e3329