Aims Endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage
(PTBD) are the two minimally invasive procedures for inoperable malignant biliary
obstruction. The medium-term survival of these patients after drainage is poorly documented
in the literature. The goals of this study were: (a) to determine the clinical and
biological factors associated with survival; and (b) to establish a prognostic score.
Methods All patients who had biliary drainage between April 1, 2014 and August 31, 2018 for
inoperable malignant biliary obstruction were included. Clinical and biological baseline
data were recorded retrospectively. The continuous variables of biological tests were
analyzed by ROC curves. The survival curves were estimated using the Kaplan-Meier
method and compared using the log-rank test.
Results 262 patients were included with a mean age of 73 years. Biliary tract obstruction
was due to primary cancer in 203 patients (77.5%) and metastases in 59 patients (22.5%).
373 procedures were performed with an average of 1.23 procedures per patient: 244
EBD, 127 PTBD and 2 combined procedures. Intra-hospital morbidity was 18.2%. The overall
complication rate was no different between EBD and PTBD. The median survival rate
was 4.8 months and 30-day mortality was 14%. Six variables were independently associated
with poor prognosis: performans status, metastatic obstruction, liver metastases,
weight loss > 5% in the last three months, albumin ≤ 24g/L, total bilirubin ≥ 186µmol/L.
A prognostic score was calculated from these six variables. The median survival time
was 7.5 months when the score was ≤ 2 and 2.5 months when it was > 2 (p < 0.001).
Conclusions A prognostic score was established on the basis of six variables and it was associated
with poor survival when the score > 2. It may be useful in multidisciplinary meetings
to make a decision based on the expected benefits and the risks inherent to the biliary
drainage.
