scholarly journals Preoperative biliary drainage in perihilar cholangiocarcinoma: identifying patients who require percutaneous drainage after failed endoscopic drainage

Endoscopy ◽  
2015 ◽  
Vol 47 (12) ◽  
pp. 1124-1131 ◽  
Author(s):  
Jimme Wiggers ◽  
Bas Koerkamp ◽  
Robert Coelen ◽  
Erik Rauws ◽  
Mark Schattner ◽  
...  
Keyword(s):  
Percutaneous Drainage ◽  
Biliary Drainage ◽  
Preoperative Biliary Drainage ◽  
Perihilar Cholangiocarcinoma ◽  
Endoscopic Drainage

Biliary Drainage Before and After Liver Resection for Perihilar Cholangiocarcinoma

2020 ◽  
Vol 86 (6) ◽  
pp. 628-634
Author(s):  
Laura M. Enomoto ◽  
Matthew E. B. Dixon ◽  
Allene Burdette ◽  
Niraj J. Gusani
Keyword(s):  
Biliary Drainage ◽  
Future Liver Remnant ◽  
Preoperative Biliary Drainage ◽  
Perihilar Cholangiocarcinoma ◽  
Patient Specific ◽  
Liver Remnant ◽  
Biliary Sepsis ◽  
Before And After

Perihilar cholangiocarcinoma (PHC) is a rare tumor that requires surgical resection for a potential cure. The role of preoperative biliary drainage has long been debated, given its treatment of biliary sepsis and decompression of the future liver remnant (FLR), but high procedure-specific morbidity. The indications, methods, and outcomes for preoperative biliary drainage are discussed to serve as a guide for perioperative management of patients with resectable PHC. Multiple studies from the literature related to perihilar cholangiocarcinoma, biliary drainage, and management of the FLR were reviewed. Commonly employed preoperative biliary drainage includes endoscopic biliary stenting and percutaneous transhepatic biliary drainage. Drainage of the FLR remains controversial, with most experts recommending drainage of the only in patients with an FLR <50%. Biliary drainage for resectable PHC requires a patient-specific approach with careful determination of the FLR and balancing of potential morbidity with the benefits of drainage.

scholarly journals Percutaneous Preoperative Biliary Drainage for Resectable Perihilar Cholangiocarcinoma: No Association with Survival and No Increase in Seeding Metastases

2015 ◽  
Vol 22 (S3) ◽  
pp. 1156-1163 ◽  
Author(s):  
Jimme K. Wiggers ◽  
Bas Groot Koerkamp ◽  
Robert J. Coelen ◽  
Alexandre Doussot ◽  
Susan van Dieren ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Preoperative Biliary Drainage ◽  
Perihilar Cholangiocarcinoma

scholarly journals Evaluation of Liver Function and the Role of Biliary Drainage before Major Hepatic Resections

2020 ◽  
pp. 1-8
Author(s):  
Yuzo Yamamoto
Keyword(s):  
Liver Function ◽  
Portal Vein ◽  
Biliary Drainage ◽  
Future Liver Remnant ◽  
Volume Ratio ◽  
Preoperative Biliary Drainage ◽  
Perihilar Cholangiocarcinoma ◽  
Portal Vein Ligation ◽  
Liver Remnant

<b><i>Background:</i></b> Prevention of posthepatectomy liver failure is a prerequisite for improving the postoperative outcome of perihilar cholangiocarcinoma. From this perspective, appropriate assessment of future liver remnant (FLR) function and the optimized preparation are mandatory. <b><i>Summary:</i></b> FLR volume ratio using CT volumetry based on 3-dimensional vascular imaging is the current assessment yardstick and is sufficient for assessing a normal liver. However, in a liver with underling parenchymal disease such as fibrosis or prolonged jaundice, weighing up the degree of liver damage against the FLR volume ratio is necessary to know the real FLR function. For this purpose, the indocyanine green (ICG) clearance test, monoethylglycinexylidide (MEGX) test, liver maximum capacity (LiMAX) test, <sup>99m</sup>Tc-labeled galactosyl human serum albumin (<sup>99m</sup>Tc-GSA) scintigraphy, albumin-bilirubin (ALBI) grade, and ALPlat (albumin × platelets) criterion are used. After the optimization of FLR function by means of portal vein embolization or associating liver partition and PVL (portal vein ligation) for staged hepatectomy (ALPPS), SPECT scintigraphy with either <sup>99m</sup>Tc-GSA or <sup>99m</sup>Tc-mebrofenin compensates for misestimation due to the regional heterogeneity of liver function. The role of preoperative biliary drainage has long been debated, with the associated complications having led to a lack of approval. However, the recent establishment of safety and an improvement in success rates of endoscopic biliary drainage seem to be changing the awareness of the importance of biliary drainage. <b><i>Key Messages:</i></b> Appropriate selection of an assessment method is of prime importance to predict the FLR function according to the preoperative condition of the liver. Preoperative biliary drainage in patients with perihilar cholangiocarcinoma is gaining support due to the increasing safety and success rate, especially in patients who need optimization of their liver function before hepatectomy.

scholarly journals Evaluation of the Effectiveness of Endoscopic Retrograde Cholangiopancreatography in Patients with Perihilar Cholangiocarcinoma and Its Effect on Development of Cholangitis

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Serkan İpek ◽  
Emrah Alper ◽  
Cem Cekic ◽  
Serkan Cerrah ◽  
Mahmut Arabul ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Bilirubin Level ◽  
Biliary Drainage ◽  
Perihilar Cholangiocarcinoma ◽  
Endoscopic Drainage ◽  
Endoscopic Retrograde ◽  
Increased Risk

Objective.We aimed to determine the effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) in patients with inoperable perihilar cholangiocarcinoma and establish the incidence of cholangitis development following ERCP.Material and Method.This retrospective study enrolled patients diagnosed with inoperable perihilar cholangiocarcinoma who underwent endoscopic drainage (stenting) with ERCP. Patients were evaluated for development of cholangitis and the effectiveness of ERCP. The procedure was considered successful if bilirubin level fell more than 50% within 7 days after ERCP.Results.Post-ERCP cholangitis developed in 40.7% of patients. Cholangitis development was observed among 39.4% of patients with effective ERCP and in 60.6% of patients with ineffective ERCP. Development of cholangitis was significantly more common in the group with ineffective ERCP compared to the effective ERCP group (P=0.001). The average number of ERCP procedures was 2.33 ± 0.89 among patients developing cholangitis and 1.79 ± 0.97 in patients without cholangitis. The number of ERCP procedures was found to be significantly higher among patients developing cholangitis compared to those without cholangitis (P=0.012).Conclusion.ERCP may not provide adequate biliary drainage in some of the patients with perihilar cholangiocarcinoma and also it is a procedure associated an increased risk of cholangitis.

scholarly journals Comparison of an Inside Stent and a Fully Covered Self-Expandable Metallic Stent as Preoperative Biliary Drainage for Patients with Resectable Perihilar Cholangiocarcinoma Retrospectively.

2021 ◽  
Author(s):  
Hiroshi Mori ◽  
Hiroki Kawashima ◽  
Eizaburo Ohno ◽  
Takuya Ishikawa ◽  
Yasuyuki Mizutani ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Adverse Events ◽  
Pancreatic Fistula ◽  
Biliary Drainage ◽  
Preoperative Biliary Drainage ◽  
Perihilar Cholangiocarcinoma ◽  
Stent Insertion ◽  
Metallic Stent ◽  
Expandable Metallic Stent ◽  
Significant Difference

Abstract BackgroundThere is a need for a more tolerable preoperative biliary drainage (PBD) method for perihilar cholangiocarcinoma (PHCC). In recent years, inside stents (ISs) have attracted attention as a less suffering PBD method. Few studies have compared IS with a fully covered self-expandable metallic stent (FCSEMS) as PBD for resectable PHCC. The aim of this study is to compare them.MethodsThis study involved 87 consecutive patients (IS: 51, FCSEMS: 36). The recurrent biliary obstruction (RBO) rate until undergoing surgery or being diagnosed as unresectable, time to RBO, factors related to RBO, incidence of adverse events related to endoscopic retrograde cholangiography and postoperative complications associated with each stent were evaluated retrospectively.ResultsThere was no significant difference between the two groups in the incidence of adverse events after stent insertion. The mean (s.d.) time to RBO was 40.0 (28.1) days in the IS group and 52.0 (45.5) days in the FCSEMS group, with no significant difference (P=0.384). A total of 7/51 patients in the IS group and 3/36 patients in the FCSEMS group developed RBO. The only risk factor for RBO was bile duct obstruction of the future excisional liver lobe(s) due to stenting (HR 0.033, P=0.006) in the FCSEMS group, but risk factors could not be indicated in the IS group. Regarding postoperative complications, there was no significant difference in the incidence of bile leakage or liver failure. In contrast, pancreatic fistula was significantly more common in the FCSEMS group (13/24 patients) than in the IS group (3/28 patients) (P=0.001), especially in patients who did not undergo pancreatectomy (P=0.001).ConclusionsAs PBD for PHCC, both IS and FCSEMS achieved low RBO rates. In contrast, the incidence of postoperative pancreatic fistula was higher with FCSEMS. Thus, IS, which can be inserted easily, is considered an optimal approach as PBD for resectable PHCC.clinical trial registration number: UMIN000025631

scholarly journals Preoperative biliary drainage in perihilar cholangiocarcinoma: results of an Italian multicenter study

HPB ◽  
2018 ◽  
Vol 20 ◽  
pp. S185
Author(s):  
F. Ardito ◽  
L. Aldrighetti ◽  
F. Giuliante ◽  
A. Ferrero ◽  
A. Guglielmi ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Biliary Drainage ◽  
Preoperative Biliary Drainage ◽  
Perihilar Cholangiocarcinoma
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