# Jaundice-Reducing Efficacy Through Placement of Biliary Plastic Stents During Endoscopic Retrograde Cholangiography in Unresectable Malignant Hilar Biliary Obstructions

## TL;DR

This study shows that placing biliary plastic stents during endoscopic retrograde cholangiography effectively reduces jaundice in most patients with unresectable malignant hilar biliary obstruction.

## Contribution

The study evaluates the efficacy of biliary drainage using plastic stents in UMHBO and identifies potential but non-independent risk factors for poor jaundice reduction.

## Key findings

- 78.8% of patients experienced a favorable jaundice-reducing effect after stent placement.
- Pre-ERC GGT, ALT, and CA19-9 levels were higher in the good effect group but were not independent risk factors.
- No clear independent risk factors for poor jaundice reduction were identified.

## Abstract

Objective: To evaluate the efficacy of endoscopic retrograde cholangiography (ERC)-guided biliary drainage as a preliminary method for reducing jaundice in patients with unresectable malignant hilar biliary obstruction (UMHBO), and to identify risk factors associated with sub-optimal jaundice reduction.

Methods: A cohort of 33 patients with UMHBO, spanning from March 2016 to July 2024, was included in the study. A 30% reduction in total bilirubin (TB) was considered indicative of a favorable jaundice-reducing effect (TB before discharge/TB before ERC).

Results: The rate of good jaundice-reducing effect was 78.8% (26/33) with the use of biliary plastic stents during the initial ERC. Notably, pre-ERC levels of gamma glutamyltranspeptidase (GGT) and alanine aminotransferase (ALT) were lower in the poor effect group compared to the good effect group (260.0 vs. 479.5 U/L, 55.0 vs. 84.5 U/L, respectively, P < 0.05). Carbohydrate antigen 19-9 (CA19-9) was higher in the poor effect group than in the good effect group (7948.6 vs. 542.1 U/ml, P < 0.05). However, binary logistic regression analysis did not reveal that pre-ERC levels of GGT, ALT, and CA19-9 were independent risk factors for poor jaundice reduction.

Conclusion: ERC with the placement of biliary plastic stents as the initial jaundice reducing method was available in UMHBO patients. Independent risk factors that lead to poor jaundice reduction were still elusive.