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Optimal biliary drainage for inoperable Klatskin's tumor based on Bismuth type

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Authors
Lee, Sang Hyub; Park, Joo Kyung; Yoon, Won Jae; Lee, Jun Kyu; Ryu, Ji Kon; Yoon, Yong Bum; Kim, Yong-Tae
Issue Date
2007-08-01
Publisher
WJG
Citation
World J Gastroenterol. 2007; 13(29): 3948-3955
Keywords
AgedBile Duct Neoplasms/*surgery/therapyBile Ducts/pathologyBile Ducts, Intrahepatic/pathologyBiliary Tract Surgical Procedures/*methods*DrainageFemaleHepatic Duct, Common/*surgeryHumansKlatskin's Tumor/*surgery/therapyMaleMiddle AgedStentsTime FactorsTreatment Outcome
Abstract
AIM: To investigate differences in the effects of biliary drainage procedures in patients with inoperable Klatskin's tumor based on Bismuth type, considering endoscopic retrograde biliary drainage (ERBD), external percutaneous transhepatic biliary drainage (EPTBD) and internal biliary stenting via the PTBD tract (IPTBD). METHODS: The initial success rate, cumulative patency rate, and complication rate were compared retrospectively, according to the Bismuth type and ERBD, EPTBD, and IPTBD. Patency was defined as the duration for adequate initial bile drainage or to the point of the patient's death associated with inadequate drainage. RESULTS: One hundred thirty-four patients (93 men, 41 women; 21 Bismuth type II, 47 III, 66 IV; 34 ERBD, 66 EPTBD, 34 IPTBD) were recruited. There were no differences in demographics among the groups. Adequate initial relief of jaundice was achieved in 91% of patients without a significant difference in the results among different procedures or Bismuth types. The cumulative patency rates for ERBD and IPTBD were better than those for EPTBD with Bismuth type III. IPTBD provided an excellent response for Bismuth type IV. However, there was no difference in the patency rate among drainage procedures for Bismuth type II. Procedure-related cholangitis occurred less frequently with EPTBD than with ERBD and IPTBD. CONCLUSION: ERBD is recommended as the first-line drainage procedure for the palliation of jaundice in patients with inoperable Klatskin's tumor of Bismuth type II or III, but IPTBD is the best option for Bismuth type IV.
ISSN
1007-9327 (Print)
Language
English
URI
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17663508

https://hdl.handle.net/10371/68486
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College of Medicine/School of Medicine (의과대학/대학원)Internal Medicine (내과학전공)Journal Papers (저널논문_내과학전공)
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