Endoscopic nasobiliary drainage versus endoscopic biliary stenting for preoperative biliary drainage in patients with malignant hilar biliary obstruction: Propensity score-matched multicenter comparative study

Hirotoshi Ishiwatari; Takanori Kawabata; Hiroki Kawashima; Yousuke Nakai; Shin Miura; Hironari Kato; Hideyuki Shiomi; Nao Fujimori; Takeshi Ogura; Osamu Inatomi; Kensuke Kubota; Toshio Fujisawa; Mamoru Takenaka; Hiroshi Mori; Kensaku Noguchi; Yuki Fujii; Teiichi Sugiura; Noboru Ideno; Tomoki Nakafusa; Atsushi Masamune; Hiroyuki Isayama; Naoki Sasahira

doi:10.1111/den.14712

Endoscopic nasobiliary drainage versus endoscopic biliary stenting for preoperative biliary drainage in patients with malignant hilar biliary obstruction: Propensity score-matched multicenter comparative study

Dig Endosc. 2023 Oct 27. doi: 10.1111/den.14712. Online ahead of print.

Authors

Hirotoshi Ishiwatari¹, Takanori Kawabata², Hiroki Kawashima³, Yousuke Nakai⁴, Shin Miura⁵, Hironari Kato⁶, Hideyuki Shiomi^{7

8}, Nao Fujimori⁹, Takeshi Ogura¹⁰, Osamu Inatomi¹¹, Kensuke Kubota¹², Toshio Fujisawa¹³, Mamoru Takenaka¹⁴, Hiroshi Mori³, Kensaku Noguchi⁴, Yuki Fujii⁶, Teiichi Sugiura¹⁵, Noboru Ideno¹⁶, Tomoki Nakafusa¹⁶, Atsushi Masamune⁵, Hiroyuki Isayama¹³, Naoki Sasahira¹⁷

Affiliations

¹ Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.
² Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan.
³ Department of Endoscopy, Nagoya University Hospital, Aichi, Japan.
⁴ Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁵ Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan.
⁶ Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
⁷ Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan.
⁸ Division of Gastroenterology and Hepato-Biliary-Pancreatology, Department of Internal Medicine, Hyogo Medical University, Hyogo, Japan.
⁹ Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
¹⁰ Endoscopy Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan.
¹¹ Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Shiga, Japan.
¹² Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.
¹³ Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
¹⁴ Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan.
¹⁵ Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
¹⁶ Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
¹⁷ Division of Hepato-Biliary-Pancreatic Medicine, Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.

PMID: 37885412
DOI: 10.1111/den.14712

Abstract

Objectives: For preoperative biliary drainage (PBD) of malignant hilar biliary obstruction (MHBO), current guidelines recommend endoscopic nasobiliary drainage (ENBD) due to the higher risk of cholangitis after endoscopic biliary stenting (EBS) during the waiting period before surgery. However, few studies have supported this finding. Therefore, we aimed to compare the outcomes of preoperative ENBD and EBS in patients with MHBO.

Methods: Patients with MHBO who underwent laparotomy for radical surgery after ENBD or EBS were included from retrospectively collected data from 13 centers (January 2014 to December 2018). We performed a 1:1 propensity score matching between the ENBD and EBS groups. These patients were compared for the following: cholangitis and all adverse events (AEs) after endoscopic biliary drainage (EBD) until surgery, time to cholangitis development after EBD, postsurgical AEs, and in-hospital death after surgery.

Results: Of the 414 patients identified, 355 were analyzed in this study (226 for ENBD and 129 for EBS). The matched cohort included 63 patients from each group. The proportion of cholangitis after EBD was similar between the two groups (20.6% vs. 25.4%, P = 0.67), and no significant difference was observed in the time to cholangitis development. The proportions of surgical site infections, bile leaks, and in-hospital mortality rates were similar between the groups.

Conclusion: For PBD of MHBO, the proportion of AEs, including cholangitis, after EBD until surgery was similar when either ENBD or EBS was used.

Keywords: endoscopic biliary stenting; endoscopic nasobiliary drainage; malignant hilar biliary obstruction; perihilar cholangiocarcinoma; preoperative biliary drainage.