Endoscopic treatment of malignant hilar biliary obstruction: A retrospective cohort study

Table 1 Baseline characteristics of study group

Characteristics		Mean ± SD or n (%)
Sex (women/men)		86 (52.4)/78 (47.6)
Age (year)		67 ± 65.6
	≤ 60	45 (27.4)
	> 60	119 (72.6)
Etiology	Cholangiocarcinoma	102 (62.2)
	Gallbladder carcinoma	36 (21.9)
	Colorectal cancer - metastases	19 (11.6)
	Breast cancer - metastases	2 (1.2)
	HCC	2 (1.2)
	Non-small-cell lung cancer	1 (0.6)
	Neuroendocrine carcinoma	1 (0.6)
	Pancreatic cancer	1 (0.6)
Method of obtaining a histopathological result	ERCP	90 (54.9)
	Surgery	50 (30.5)
	CT-guided biopsy	17 (10.4)
	USG-guided biopsy	2 (1.2)
	HCC criteria	2 (1.2)
	Percutaneous transhepatic biliary drainage	1 (0.6)
	Paracentesis	1 (0.6)
	Endoscopic ultrasound	1 (0.6)
Time of progression to the next Bismuth degree (day)		117.3 ± 83
Number of ERCP procedures before diagnosis		1.2 ± 1.0
Total number of ERCP procedures		4.0 ± 3.0
Chemotherapy		86 (52.4)
Radiofrequency ablation		26 (15.9)
Patient presenting adverse events other then recurrent biliary obstruction	Pancreatitis	40 (24.4)
	Bleeding	15 (9.1)
	Perforation	2 (1.2)
	Liver abscesses	20 (12.2)
	Cholecystitis	2 (1.2)

ERCP: Endoscopic retrograde cholangiopancreatography; CT: Computed tomography; USG: Ultrasonography; HCC: Hepatocellular carcinoma.

Table 2 Clinical outcomes according to treatment strategy, mean ± SD

	Number of ERCP	Number of failures	Episodes of cholangitis	Occlusion time in days
Stent implantation strategy
UCSEMS	5.4 ± 3.7	0.7 ± 1.0	2.1 ± 2.0	122.5 ± 124.8
Plastic	2.5 ± 2.1	0.6 ± 1.1	0.8 ± 0.9	80.0 ± 99.9
Mixed approach	4.5 ± 2.9	0.5 ± 0.8	1.7 ± 1.5	84.4 ± 91.3
P value	< 0.0001	0.7354	0.0001	0.0066
Drainage approach
Unilateral	1.9 ± 0.9	1.5 ± 1.0	0.7 ± 0.8	115.6 ± 195.1
Bilateral	4.0 ± 3.4	0.4 ± 0.9	1.5 ± 1.7	99.4 ± 111.4
P value	0.0276	0.0001	0.2412	0.2748
Stent type
Plastic	3.4 ± 2.7	0.5 ± 1.0	1.2 ± 1.3	82.1 ± 95.5
Metal	5.4 ± 3.7	0.7 ± 1.0	2.1 ± 2.0	122.5 ± 124.8
P value	0.0001	0.5364	0.0076	0.0032
Adjunctive therapy
RFA	7.6 ± 4.2	0.5 ± 1.0	3.0 ± 2.4	79.6 ± 43.7
Non-RFA	3.3 ± 2.4	0.6 ± 1.0	1.2 ± 1.2	96.3 ± 113.9
P value	< 0.0001	0.4589	0.0002	0.5418
Chemotherapy	3.1 ± 2.5	0.4 ± 0.6	1.7 ± 1.7	103.6 ± 101.9
Non-chemotherapy	4.8 ± 3.5	0.7 ± 1.2	1.2 ± 1.4	82.7 ± 109.9
P value	0.0002	0.6782	0.0509	0.0042

ERCP: Endoscopic retrograde cholangiopancreatography; UCSEMS: Uncovered self-expandable metal stents; RFA: Radiofrequency ablation.

Table 3 Correlation of selected clinical parameters with overall survival time

	r value	P value
Age	-0.13	0.1004
Time to progression to the next Bismuth stage	0.56	0.0035
Number of ERCP procedures before diagnosis	0.28	0.0003
Number of ERCP procedures after placement of UCSEMS stents	0.55	0.0004
Total number of ERCP procedures	0.69	0.0001
Number of cholangitis episodes in patients with UCSEMS	0.39	0.0467
Number of cholangitis episodes in patients with unilateral plastic	-0.24	0.1666
Number of cholangitis episodes in patients with bilateral plastic	0.19	0.1060
Number of cholangitis episodes in patients with mixed approach group	0.04	0.7837
Number of failed ERCP	0.01	0.9236

ERCP: Endoscopic retrograde cholangiopancreatography; UCSEMS: Uncovered self-expandable metal stents.