Malignant Biliary Strictures: Preoperative and Palliative Interventions

Abstract

Malignant biliary strictures represent a significant clinical challenge worldwide, with the majority of cases being unresectable at the time of diagnosis, necessitating palliative biliary drainage. In some cases, preoperative drainage is required to optimize surgical outcomes. Biliary drainage can be performed through either endoscopic or percutaneous methods, each tailored to specific clinical scenarios. Endoscopic techniques include endoscopic retrograde cholangiopancreatography, endoscopic nasobiliary drainage, and endoscopic ultrasound-guided biliary drainage, while percutaneous options involve percutaneous transhepatic biliary drainage and biliary stenting. The choice of technique is guided by imaging findings, the clinical condition of the patient, and the expertise of the interventionist to ensure effective drainage and minimize complications. Although endoscopic methods are well-established and extensively studied, the percutaneous approach offers distinct advantages in certain complex cases. This review provides a comprehensive overview of biliary drainage techniques, with a particular focus on the percutaneous approach.

Keywords

malignant biliary strictures - percutaneous transhepatic biliary drainage - palliative biliary interventions

Publikationsverlauf

Eingereicht: 10. Juni 2024

Angenommen: 02. Dezember 2024

Artikel online veröffentlicht:
06. Januar 2025

• References

• 1 Ouyang G, Liu Q, Wu Y. et al. The global, regional, and national burden of gallbladder and biliary tract cancer and its attributable risk factors in 195 countries and territories, 1990 to 2017: a systematic analysis for the Global Burden of Disease Study 2017. Cancer 2021; 127 (13) 2238-2250
• 2 Crosara Teixeira M, Mak MP, Marques DF. et al. Percutaneous transhepatic biliary drainage in patients with advanced solid malignancies: prognostic factors and clinical outcomes. J Gastrointest Cancer 2013; 44 (04) 398-403
• 3 Hameed A, Pang T, Chiou J. et al. Percutaneous vs. endoscopic pre-operative biliary drainage in hilar cholangiocarcinoma - a systematic review and meta-analysis. HPB (Oxford) 2016; 18 (05) 400-410
• 4 Duan F, Cui L, Bai Y, Li X, Yan J, Liu X. Comparison of efficacy and complications of endoscopic and percutaneous biliary drainage in malignant obstructive jaundice: a systematic review and meta-analysis. Cancer Imaging 2017; 17 (01) 27
• 5 Moole H, Dharmapuri S, Duvvuri A. et al. Endoscopic versus percutaneous biliary drainage in palliation of advanced malignant hilar obstruction: a meta-analysis and systematic review. Can J Gastroenterol Hepatol 2016; 2016: 4726078
• 6 Choi J, Ryu JK, Lee SH. et al. Biliary drainage for obstructive jaundice caused by unresectable hepatocellular carcinoma: the endoscopic versus percutaneous approach. Hepatobiliary Pancreat Dis Int 2012; 11 (06) 636-642
• 7 Kim KM, Park JW, Lee JK, Lee KH, Lee KT, Shim SG. A comparison of preoperative biliary drainage methods for perihilar cholangiocarcinoma: endoscopic versus percutaneous transhepatic biliary drainage. Gut Liver 2015; 9 (06) 791-799
• 8 Sharaiha RZ, Khan MA, Kamal F. et al. Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails: a systematic review and meta-analysis. Gastrointest Endosc 2017; 85 (05) 904-914
• 9 Paik WH, Loganathan N, Hwang JH. Preoperative biliary drainage in hilar cholangiocarcinoma: When and how?. World J Gastrointest Endosc 2014; 6 (03) 68-73
• 10 Saluja SS, Gulati M, Garg PK. et al. Endoscopic or percutaneous biliary drainage for gallbladder cancer: a randomized trial and quality of life assessment. Clin Gastroenterol Hepatol 2008; 6 (08) 944-950.e3
• 11 Lee SH, Park JK, Yoon WJ. et al. Optimal biliary drainage for inoperable Klatskin's tumor based on Bismuth type. World J Gastroenterol 2007; 13 (29) 3948-3955
• 12 Gupta P, Gupta J, Kumar MP. Imaging in obstructive jaundice: what a radiologist needs to know before doing a percutaneous transhepatic biliary drainage. J Clin Interv Radiol ISVIR 2020; 4 (01) 31-37
• 13 Sharma MP, Ahuja V. Aetiological spectrum of obstructive jaundice and diagnostic ability of ultrasonography: a clinician's perspective. Trop Gastroenterol 1999; 20 (04) 167-169
• 14 Sutter CM, Ryu RK. Percutaneous management of malignant biliary obstruction. Tech Vasc Interv Radiol 2015; 18 (04) 218-226
• 15 Devane AM, Annam A, Brody L. et al. Society of Interventional Radiology Quality Improvement Standards for percutaneous cholecystostomy and percutaneous transhepatic biliary interventions. J Vasc Interv Radiol 2020; 31 (11) 1849-1856
• 16 Fairchild AH, Hohenwalter EJ, Gipson MG. et al; Expert Panel on Interventional Radiology. ACR Appropriateness Criteria^® radiologic management of biliary obstruction. J Am Coll Radiol 2019; 16 (5S): S196-S213
• 17 Zhao XQ, Dong JH, Jiang K, Huang XQ, Zhang WZ. Comparison of percutaneous transhepatic biliary drainage and endoscopic biliary drainage in the management of malignant biliary tract obstruction: a meta-analysis. Dig Endosc 2015; 27 (01) 137-145
• 18 van Delden OM, Laméris JS. Percutaneous drainage and stenting for palliation of malignant bile duct obstruction. Eur Radiol 2008; 18 (03) 448-456
• 19 Al Mahjoub A, Menahem B, Fohlen A. et al. Preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma: Is percutaneous transhepatic biliary drainage safer and more effective than endoscopic biliary drainage? A meta-analysis. J Vasc Interv Radiol 2017; 28 (04) 576-582
• 20 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 (01) 119-125
• 21 Tang Z, Yang Y, Meng W, Li X. Best option for preoperative biliary drainage in Klatskin tumor: a systematic review and meta-analysis. Medicine (Baltimore) 2017; 96 (43) e8372
• 22 Liu JG, Wu J, Wang J. et al. Endoscopic biliary drainage versus percutaneous transhepatic biliary drainage in patients with resectable hilar cholangiocarcinoma: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A 2018; 28 (09) 1053-1060
• 23 Coelen RJS, Roos E, Wiggers JK. et al. Endoscopic versus percutaneous biliary drainage in patients with resectable perihilar cholangiocarcinoma: a multicentre, randomised controlled trial. Lancet Gastroenterol Hepatol 2018; 3 (10) 681-690
• 24 Rees J, Mytton J, Evison F, Mangat KS, Patel P, Trudgill N. The outcomes of biliary drainage by percutaneous transhepatic cholangiography for the palliation of malignant biliary obstruction in England between 2001 and 2014: a retrospective cohort study. BMJ Open 2020; 10 (01) e033576
• 25 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
• 26 Walter T, Ho CS, Horgan AM. et al. Endoscopic or percutaneous biliary drainage for Klatskin tumors?. J Vasc Interv Radiol 2013; 24 (01) 113-121
• 27 Jang SI, Hwang JH, Lee KH. et al. Percutaneous biliary approach as a successful rescue procedure after failed endoscopic therapy for drainage in advanced hilar tumors. J Gastroenterol Hepatol 2017; 32 (04) 932-938
• 28 Gupta P, Maralakunte M, Rathee S. et al. Percutaneous transhepatic biliary drainage in patients at higher risk for adverse events: experience from a tertiary care referral center. Abdom Radiol (NY) 2020; 45 (08) 2547-2553
• 29 Xu C, Huang XE, Wang SX, Lv PH, Sun L, Wang FA. Comparison of infection between internal-external and external percutaneous transhepatic biliary drainage in treating patients with malignant obstructive jaundice. Asian Pac J Cancer Prev 2015; 16 (06) 2543-2546
• 30 Thornton RH, Frank BS, Covey AM. et al. Catheter-free survival after primary percutaneous stenting of malignant bile duct obstruction. AJR Am J Roentgenol 2011; 197 (03) W514-W518
• 31 Chatzis N, Pfiffner R, Glenck M, Stolzmann P, Pfammatter T, Sharma P. Comparing percutaneous primary and secondary biliary stenting for malignant biliary obstruction: a retrospective clinical analysis. Indian J Radiol Imaging 2013; 23 (01) 38-45
• 32 Perez-Johnston R, Deipolyi AR, Covey AM. Percutaneous biliary interventions. Gastroenterol Clin North Am 2018; 47 (03) 621-641
• 33 van der Merwe SW, van Wanrooij RLJ, Bronswijk M. et al. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2022; 54 (02) 185-205
• 34 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
• 35 Fang Y, Gurusamy KS, Wang Q. et al. Pre-operative biliary drainage for obstructive jaundice. Cochrane Database Syst Rev 2012; 9 (09) CD005444
• 36 Elmunzer BJ, Maranki JL, Gómez V. et al. ACG Clinical Guideline: diagnosis and management of biliary strictures. Am J Gastroenterol 2023; 118 (03) 405-426
• 37 Nagino M, Hirano S, Yoshitomi H. et al. Clinical practice guidelines for the management of biliary tract cancers 2019: the 3rd English edition. J Hepatobiliary Pancreat Sci 2021; 28 (01) 26-54
• 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 Briggs CD, Irving GR, Cresswell A. et al. Percutaneous transhepatic insertion of self-expanding short metal stents for biliary obstruction before resection of pancreatic or duodenal malignancy proves to be safe and effective. Surg Endosc 2010; 24 (03) 567-571
• 40 Decker C, Christein JD, Phadnis MA, Wilcox CM, Varadarajulu S. Biliary metal stents are superior to plastic stents for preoperative biliary decompression in pancreatic cancer. Surg Endosc 2011; 25 (07) 2364-2367
• 41 Cameron JL, Pitt HA, Zinner MJ, Kaufman SL, Coleman J. Management of proximal cholangiocarcinomas by surgical resection and radiotherapy. Am J Surg 1990; 159 (01) 91-97 , discussion 97–98
• 42 Joliat GR, Kobayashi K, Hasegawa K. et al. Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations 2022. World J Surg 2023; 47 (01) 11-34
• 43 Mehrabi A, Khajeh E, Ghamarnejad O. et al. Meta-analysis of the efficacy of preoperative biliary drainage in patients undergoing liver resection for perihilar cholangiocarcinoma. [published correction appears in Eur J Radiol. 2020 Jul; 128:109004] Eur J Radiol 2020; 125: 108897
• 44 Robson PC, Heffernan N, Gonen M. et al. Prospective study of outcomes after percutaneous biliary drainage for malignant biliary obstruction. Ann Surg Oncol 2010; 17 (09) 2303-2311
• 45 Brown KT, Covey AM. Management of malignant biliary obstruction. Tech Vasc Interv Radiol 2008; 11 (01) 43-50
• 46 Khan SA, Davidson BR, Goldin R. et al; British Society of Gastroenterology. Guidelines for the diagnosis and treatment of cholangiocarcinoma: consensus document. Gut 2002; 51 (Suppl 6, Suppl 6) VI1-VI9
• 47 Matsubara S, Nakagawa K, Suda K, Otsuka T, Oka M, Nagoshi S. Practical tips for safe and successful endoscopic ultrasound-guided hepaticogastrostomy: a state-of-the-art technical review. J Clin Med 2022; 11 (06) 1591
• 48 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
• 49 Gamanagatti S, Singh T, Sharma R, Srivastava DN, Dash NR, Garg PK. Unilobar versus bilobar biliary drainage: effect on quality of life and bilirubin level reduction. Indian J Palliat Care 2016; 22 (01) 50-62
• 50 Vienne A, Hobeika E, Gouya H. et al. Prediction of drainage effectiveness during endoscopic stenting of malignant hilar strictures: the role of liver volume assessment. Gastrointest Endosc 2010; 72 (04) 728-735
• 51 Gupta P, Bansal V, Kalra N. et al. Should patients with unresectable gallbladder cancer with hilar involvement undergo unilateral or bilateral percutaneous biliary drainage in the setting of cholangitis?. Clin Exp Hepatol 2021; 7 (01) 7-12
• 52 Müller T, Braden B. Ultrasound-guided interventions in the biliary system. Diagnostics (Basel) 2024; 14 (04) 403