Clinical Outcome of Endoscopic Transpapillary Drainage for Biliary Obstruction Due to Non-Hepato-Pancreato-Biliary Cancer: A Two-Center Retrospective Cohort Study

TL;DR

This study evaluates the effectiveness of endoscopic drainage for biliary blockage caused by non-HPB cancers, showing high success rates and factors influencing survival.

Contribution

The study provides new clinical evidence on the efficacy of endoscopic drainage for biliary obstruction in non-HPB cancer patients.

Findings

Endoscopic transpapillary drainage achieved 100% technical success and 81% clinical success.

Systemic chemotherapy after drainage was associated with significantly longer overall survival.

Serum albumin >3.1 g/dL and chemotherapy introduction were independent predictors of prolonged survival.

Abstract

Objective: Although non-hepato-pancreato-biliary (non-HPB) cancer, such as gastric and colorectal cancer, may cause biliary obstruction, the efficacy of endoscopic transpapillary drainage remains unclear. We investigated the clinical outcomes of endoscopic transpapillary drainage for biliary obstruction due to non-HPB cancer. Methods: This was a two-center retrospective observation study. We evaluated the technical success, clinical success, recurrent biliary obstruction (RBO), time to RBO (TRBO), adverse events (AEs), and overall survival (OS). OS was determined using the Kaplan–Meier method, and the significance was tested using the log-rank test. Cox regression hazard models were performed to identify the independent association of clinical parameters with OS. Results: This study included 43 cases. The technical success was achieved in all cases (100%), and the clinical success was achieved in 35 cases (81%). The occurrence rate of RBO and non-RBO AEs were 33% and 12%, respectively. The median TRBO was 176 days. Systemic chemotherapy was introduced in 17 cases (40%) after biliary drainage, and cases with the introduction of systemic chemotherapy had a significantly longer OS. C-reactive protein <3.4 mg/dL and biliary obstruction due to lymph node metastasis were independently associated with the introduction of systemic chemotherapy. In survival analysis, serum albumin >3.1 g/dL and the introduction of systemic chemotherapy were significant and independent predictive factors for the prolongation of OS. Conclusions: The endoscopic transpapillary drainage for biliary obstruction due to non-HPB cancer can provide favorable outcomes with appropriate patient selection.

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