Biliary drainage strategy of unresectable malignant hilar strictures by computed tomography volumetry

Table 1 Clinical features of 78 patients with malignant hilar strictures n (%)

Characteristic
Age (yr), mean ± SD	74.8 ± 10.3
Gender, male/female	53/25
Etiology
Cholangiocarcinoma	50 (64)
Hepatocellular carcinoma	10 (13)
Gallbladder carcinoma	9 (12)
Liver metastasis	5 (6)
Lymph node metastasis	4 (5)
Bismuth type (II/IIIa/IIIb/IV)	11/24/7/36
Total bilirubin (mg/dL), median (range)	9.0 (3.0-31.0)
Cholangitis	13 (17)
Liver function
Preserved liver function (without decompensated liver cirrhosis)	64 (82)
Impaired liver function (with decompensated liver cirrhosis)	14 (18)
Drainage method (MS/PS/ENBD/PTBD)	11/38/21/8
Drainage areas
Unilateral/bilateral	72/6
Drained liver volume (%), mean ± SD	44.6 ± 18.6

MS: Metal stent; PS: Plastic stent; ENBD: Endoscopic nasobiliary drainage; PTBD: Percutaneous transhepatic biliary drainage.

Table 2 Predictors of initial drainage effectiveness by univariate analysis n (%)

	Effective (n = 49)	Ineffective (n = 29)	P value
Age (yr), mean ± SD	74.0 ± 11.6	76.0 ± 7.5	0.39
Gender, male/female	32/17	21/8	0.78
Etiology, cholangiocarcinoma	32 (65.3)	18 (62.1)	0.81
Bismuth type IV	17 (34.6)	19 (65.5)	0.02
Total bilirubin (mg/dL), mean ± SD	9.9 ± 6.3	10.0 ± 4.7	0.93
Cholangitis	8 (16.3)	5 (17.2)	0.91
Impaired liver function	5 (10.2)	9 (31.0)	0.03
Drainage method, endoscopic drainage	43 (87.8)	27 (93.1)	0.71
Type of stent, metal stent	7 (14.3)	4 (13.8)	1.00
Drainage areas
Unilateral/bilateral	43/6	29/0	0.16
Drained liver volume (%), mean ± SD	51.1 ± 18.6	33.5 ± 12.5	< 0.01

Table 3 Predictors of initial drainage effectiveness by multivariate analysis

Factors	OR	95%CI	P value
Bismuth type IV	0.92	0.245-3.418	0.896
Impaired liver function	0.06	0.009-0.426	0.005
Drained liver volume	2.92	1.648-5.197	< 0.001

Table 4 Predictors of drainage-associated cholangitis by univariate analysis n (%)

	Cholangitis	Non-cholangitis	P value
	n = 9	n = 69
Age (yr), mean ± SD	76.9 ± 8.3	74.5 ± 10.5	0.51
Gender, male/female	5/4	48/21	0.46
Etiology, cholangiocarcinoma	6 (66.7)	44 (63.8)	1.00
Bismuth type IV)	6 (66.7)	30 (43.5)	0.29
Total bilirubin (mg/dL)	8.3 ± 3.5	10.6 ± 6.1	0.12
Impaired liver function	2 (22.2)	7 (10.1)	0.66
Drainage method, endoscopic drainage	7 (77.8)	63 (91.3)	0.23
Type of stent, metal stent	1 (11.1)	10 (14.5)	1.00
Drainage areas
Unilateral/bilateral	9/0	63/6	1.00
Drained liver volume (%), mean ± SD	29.3 ± 4.4	46.6 ± 18.9	< 0.01