An Unsuccessful Randomized Trial of Percutaneous vs Endoscopic Drainage of Suspected Malignant Hilar Obstruction.

B Joseph Elmunzer, Zachary L Smith, Paul Tarnasky, Andrew Y Wang, Patrick Yachimski, Filip Banovac, Jonathan M Buscaglia, James Buxbaum, Amitabh Chak, Bradford Chong, Gregory A Coté, Peter V Draganov, Kulwinder Dua, Valerie Durkalski, Brian S Geller, Laith H Jamil, Rajesh N Keswani, Mouen A Khashab, Ryan Law, Simon K Lo, Sean McCarthy, J Bayne Selby, Vikesh K Singh, Jason R Taylor, Field F Willingham, Rebecca L Spitzer, Lydia D Foster

Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2021;19(6):1282-1284

PMID: 32454259

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Abstract

Percutaneous transhepatic biliary drainage (PTBD) and endoscopic retrograde cholangiopancreatography (ERCP) are widely accepted but competing approaches for the management of malignant obstruction at the hilum of the liver. ERCP is favored in the United States on the basis of high success rates for non-hilar indications, the perceived safety and superior tissue sampling capability of ERCP relative to PTBD, and the avoidance of external drains that are undesirable to patients. A recent randomized controlled trial (RCT) comparing the 2 modalities in patients with resectable hilar cholangiocarcinoma was terminated prematurely because of higher mortality in the PTBD group. In contrast, most observational data suggest that PTBD is superior for achieving complete drainage. Because the preferred procedure remains uncertain, we aimed to compare PTBD and ERCP as the primary intervention in patients with cholestasis due to malignant hilar obstruction (MHO).

Address: Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina. Electronic address: [email protected].; Division of Gastroenterology and Liver Disease, Case Western Reserve University, Cleveland, Ohio.; Division of Gastroenterology, Methodist Dallas Medical Center, Dallas, Texas.; Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia.; Division of Gastroenterology, Vanderbilt University, Nashville, Tennessee.; Division of Interventional Radiology, Vanderbilt University, Nashville, Tennessee.; Division of Gastroenterology, Stony Brook University, Stony Brook, New York.; Division of Gastroenterology, University of Southern California, Los Angeles, California.; Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina.; Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida.; Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin.; Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.; Division of Interventional Radiology, University of Florida, Gainesville, Florida.; Division of Gastroenterology, Cedars Sinai Medical Center, Los Angeles, California.; Division of Gastroenterology, Northwestern University, Chicago, Illinois.; Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland.; Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan.; Division of Gastroenterology, Ohio State University, Columbus, Ohio.; Division of Interventional Radiology, Medical University of South Carolina, Charleston, South Carolina.; Division of Gastroenterology, Saint Louis University, St Louis, Missouri.; Division of Digestive Diseases, Emory University, Atlanta, Georgia.

DOI: 10.1016/j.cgh.2020.05.035

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MeSH Terms: Bile Duct Neoplasms, Bile Ducts, Intrahepatic, Cholangiopancreatography, Endoscopic Retrograde, Cholestasis, Drainage, Endosonography, Humans