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Prediction of drainage effectiveness during endoscopic stenting of malignant hilar strictures: the role of liver volume assessment.

Abstract：

BACKGROUND:The optimal endoscopic approach to the drainage of malignant hilar strictures remains controversial, especially with regard to the extent of desirable drainage and unilateral or bilateral stenting. OBJECTIVE:To identify useful criteria for predicting successful endoscopic drainage. DESIGN AND SETTING:Retrospective 2-center study in the greater Paris area in France. PATIENTS:A total of 107 patients who had undergone endoscopic stenting for hilar tumors Bismuth type II, III, or IV and a set of contemporaneous cross-sectional imaging data available. INTERVENTIONS:The relative volumetry of the 3 main hepatic sectors (left, right anterior, and right posterior) was assessed on CT scans. The liver volume drained was estimated and classified into 1 of 3 classes: less than 30%, 30% to 50%, and more than 50% of the total liver volume. MAIN OUTCOME MEASUREMENTS:The primary outcome was effective drainage, defined as a decrease in the bilirubin level of more than 50% at 30 days after drainage. Secondary outcomes were early cholangitis rate and survival. RESULTS:The main factor associated with drainage effectiveness was a liver volume drained of more than 50% (odds ratio 4.5, P = .001), especially in Bismuth III strictures. Intubating an atrophic sector (<30%) was useless and increased the risk of cholangitis (odds ratio 3.04, P = .01). A drainage > 50% was associated with a longer median survival (119 vs 59 days, P = .005). LIMITATIONS:Heterogeneous population and volume assessment methodology to improve in further prospective studies. CONCLUSION:Draining more than 50% of the liver volume, which frequently requires bilateral stent placement, seems to be an important predictor of drainage effectiveness in malignant, especially Bismuth III, hilar strictures. A pre-ERCP assessment of hepatic volume distribution on cross-sectional imaging may optimize endoscopic procedures.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Vienne A,Hobeika E,Gouya H,Lapidus N,Fritsch J,Choury AD,Chryssostalis A,Gaudric M,Pelletier G,Buffet C,Chaussade S,Prat F

doi

10.1016/j.gie.2010.06.040

subject

Has Abstract

pub_date

2010-10-01 00:00:00

pages

728-35

issue

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(10)01782-7

journal_volume

pub_type

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Prediction of drainage effectiveness during endoscopic stenting of malignant hilar strictures: the role of liver volume assessment.