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


CONCLUSIONS
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.
Department of Internal Medicine, Seoul National University Hospital, 28 Yungun-dong, Chongno-gu, Seoul, 110-744, South Korea. yongtkim@snu.ac.kr
Sang Hyub
SH
Lee
Joo Kyung
JK
Park
Won Jae
WJ
Yoon
Jun Kyu
JK
Lee
Ji Kon
JK
Ryu
Yong Bum
YB
Yoon
Yong-Tae
YT
Kim
D000368:Aged; D001650:Bile Duct Neoplasms / Q000601:surgery* / Q000628:therapy; D001652:Bile Ducts / Q000473:pathology; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D004322:Drainage; D005260:Female; D006500:Hepatic Duct, Common / Q000601:surgery*; D006801:Humans; D018285:Klatskin Tumor / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome