Billiary drainage in obstructive jaundice

Abstract

In patients with obstructive jaundice, when the endoscopic approach fails to achieve biliary drainage, percutaneous cannulation and combined endoscopic/percutaneous endoprosthesis insertion can simultaneously or subsequently be performed. The present study compares these two approaches. Endoscopic retrograde biliary drainage (ER BD) and percutaneous transhepatic biliary drainage (PTBD) are the two main non-surgical treatment options for obstructive jaundice in patients with hepatocellular carcinoma (HCC). ER BD is usually the first-line treatment because of its low hemorrhage risk. Some authors have reported that the successful drainage rate ranges from 72 to 100%. Mean stent patency time and mean survival range from 1,0 to 15,9 and from 2,8 to 12,3 months, respectively. PTBD is often an important second-line treatment when ER BD is impossible. With regard to materials, metallic stents offer the benefit of longer patency than plastic stents. The dominant effect of biliary drainage suggests that successful jaundice therapy could enhance anticancer treatment by increasing the life expectancy, decreasing the mortality, or both. We present an overview of the efficacy of ER BD and PTBD for obstructive jaundice in HCC patients who are not candidates for surgical resection and summarize the current indications and outcomes of reported clinical use. Traditionally, surgical techniques have been used, however, in the last 20 years the availability of both endoscopic and interventional radiological procedures has increased. Тhe technical success of the procedure depends on the experience of the interventional radiologist performing the drainage. It can be as high as nearly 100%. Clinical efficacy is usually lower but still over 90%. When endoscopic drainage alone fails, a combined percutaneous/ endoscopic procedure should only be performed if it can be carried out simultaneously.