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Outcomes of preoperative endoscopic nasobiliary drainage and endoscopic retrograde biliary drainage for malignant distal biliary obstruction prior to pancreaticoduodenectomy.
- Source :
-
World journal of gastroenterology [World J Gastroenterol] 2017 Aug 07; Vol. 23 (29), pp. 5386-5394. - Publication Year :
- 2017
-
Abstract
- Aim: To compare the outcomes of preoperative endoscopic nasobiliary drainage (ENBD) and endoscopic retrograde biliary drainage (ERBD) in patients with malignant distal biliary obstruction prior to pancreaticoduodenectomy (PD).<br />Methods: Data from 153 consecutive patients who underwent preoperative endoscopic biliary drainage prior to PD between January 2009 and July 2016 were analyzed. We compared the clinical data, procedure-related complications of endoscopic biliary drainage (EBD) and postoperative complications of PD between the ENBD and ERBD groups. Univariate and multivariate analyses with odds ratios (ORs) and 95% confidence intervals (95%CIs) were used to identify the risk factors for deep abdominal infection after PD.<br />Results: One hundred and two (66.7%) patients underwent ENBD, and 51 (33.3%) patients underwent ERBD. Endoscopic sphincterotomy was less frequently performed in the ENBD group than in the ERBD group ( P = 0.039); the EBD duration in the ENBD group was shorter than that in the ERBD group ( P = 0.036). After EBD, the levels of total bilirubin (TB) and alanine aminotransferase (ALT) were obviously decreased in both groups, and the decreases of TB and ALT in the ERBD group were greater than those in the ENBD group ( P = 0.004 and P = 0.000, respectively). However, the rate of EBD procedure-related cholangitis was significantly higher in the ERBD group than in the ENBD group ( P = 0.007). The postoperative complications of PD as graded by the Clavien-Dindo classification system were not significantly different between the two groups ( P = 0.864). However, the incidence of deep abdominal infection after PD was significantly lower in the ENBD group than in the ERBD group ( P = 0.019). Male gender (OR = 3.92; 95%CI: 1.63-9.47; P = 0.002), soft pancreas texture (OR = 3.60; 95%CI: 1.37-9.49; P = 0.009), length of biliary stricture (≥ 1.5 cm) (OR = 5.20; 95%CI: 2.23-12.16; P = 0.000) and ERBD method (OR = 4.08; 95%CI: 1.69-9.87; P = 0.002) were independent risk factors for deep abdominal infection after PD.<br />Conclusion: ENBD is an optimal method for patients with malignant distal biliary obstruction prior to PD. ERBD is superior to ENBD in terms of patient tolerance and the effect of biliary drainage but is associated with an increased risk of EBD procedure-related cholangitis and deep abdominal infection after PD.<br />Competing Interests: Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this report.
- Subjects :
- Aged
Bile Duct Neoplasms complications
Bile Ducts pathology
Bile Ducts surgery
Cholangiopancreatography, Endoscopic Retrograde instrumentation
Cholestasis etiology
Drainage instrumentation
Drainage methods
Female
Humans
Incidence
Intraabdominal Infections etiology
Male
Middle Aged
Postoperative Complications etiology
Preoperative Care
Risk Factors
Sphincterotomy, Endoscopic instrumentation
Stents adverse effects
Time Factors
Treatment Outcome
Bile Duct Neoplasms surgery
Cholangiopancreatography, Endoscopic Retrograde adverse effects
Cholestasis surgery
Drainage adverse effects
Intraabdominal Infections epidemiology
Pancreaticoduodenectomy adverse effects
Postoperative Complications epidemiology
Sphincterotomy, Endoscopic adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 2219-2840
- Volume :
- 23
- Issue :
- 29
- Database :
- MEDLINE
- Journal :
- World journal of gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 28839439
- Full Text :
- https://doi.org/10.3748/wjg.v23.i29.5386