• Jennifer Nakamura Ruas, Ernesto Quaresma Mendonça, Luciano Lenz, Gustavo Andrade de Paulo, Ricardo Uemura Sato, José Jukemura, JuniorUlysses RibeiroURDepartment of Gastroenterology of Universidade de São Paulo, São Paulo, SP, Brazil; Division of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil., Fauze Maluf-Filho, and Bruno Costa Martins.
• Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil; Department of Gastroenterology of Universidade de São Paulo, São Paulo, SP, Brazil. Electronic address: dra.jennifer@outlook.com.
• Clinics (Sao Paulo). 2025 Jan 1; 80: 100540100540.

Background And AimMalignant hilar obstruction usually presents in advanced-stage disease with a poor prognosis. Effective biliary drainage is essential for the beginning of palliative chemotherapy. There is a debate on the amount of liver parenchyma that should be drained to achieve clinical success. This study aimed to correlate the volume of liver drained with clinical success rate.MethodsThe authors conducted a retrospective study including patients with malignant hilar biliary obstruction who underwent retrograde endoscopic cholangiography for biliary drainage from January 2014 to December 2018. The main outcome was a correlation of clinical success rate with hepatic volume drained. Secondary outcomes were correlation of clinical success rate with the quantity of liver sectors drained and unilateral versus bilateral drainage.Results82 patients met inclusion criteria (58.5 % female), with a mean age of 60±13 years. The main cause of hilar obstruction was cholangiocarcinoma (32.9 %) followed by lymph node metastasis (23.2 %). Technical success was achieved in 75 patients (91.5 %), and clinical success in 45 patients (60 %). The authors found a significant correlation between clinical success rate when at least 50 % of viable parenchyma was drained (p = 0.016; OR = 4.15, 95 % CI 1.4-12.5). Considering liver sectors, higher clinical success rates were found when at least 2 sectors were drained (p < 0.001; OR = 8.50, 95 % CI 2.7-26.7). The correlation between unilateral versus bilateral drainage and clinical success was not statistically significant.ConclusionDrainage of at least 50 % of volume hepatic parenchyma was associated with better outcomes as well as drainage of at least 2 hepatic sectors, regardless of if unilateral or bilateral.Copyright © 2024 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.

27 keywords...

hide…