Contrast-free air cholangiography-assisted unilateral plastic stenting in malignant hilar biliary obstruction.
BACKGROUND
Endoscopic palliation in malignant hilar biliary obstruction requires endoscopic retrograde cholangiopancreatography (ERCP), whereas contrast injection leads to cholangitis. Contrast-free metal stenting with or without magnetic resonance cholangiopancreatography (MRCP) has shown encouraging results, but MRCP and metal stents are costly. There have been no reports on the use of air cholangiography.


METHODS
We prospectively evaluated the role of air cholangiography-assisted unilateral plastic stenting in 10 patients with type II malignant hilar biliary obstruction. A retrospectively analysed group of 10 patients treated with contrast-free unilateral metal stenting served as historical controls.


RESULTS
Ten patients with unresectable type II malignant hilar biliary obstruction were studied. Air cholangiography detected type II obstruction in all patients, similar to MRCP. The patients underwent unilateral stenting. Successful endoscopic drainage was achieved in all patients. The mean patency of the stent was 95.8+/-17.5 days in the study group and 143.9+/-115.1 days in the control group (P=0.20). The mean survival was 121.8+/-41.6 days in the study group and 154.9+/-122.5 days in the control group (P=0.42). Kaplan-Meier analysis showed an estimated median survival of 100:95% CI (65.9, 134.1) days in the study group and 98:95% CI (84.1, 111.9) days in the control group (P=0.62). Cholangitis occurred in none of the patients and there were no 30-day deaths nor major complications. Air cholangiography-assisted unilateral plastic stenting was cheaper than contrast-free unilateral metal stenting.


CONCLUSIONS
Air cholangiography-assisted unilateral plastic stenting is as safe and effective as contrast-free unilateral metal stenting in type II malignant hilar biliary obstruction for palliating patients, but it is cheaper.
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India. virendrasingh100@ hotmail.com
Virendra
V
Singh
Gurpreet
G
Singh
Vikas
V
Gupta
Rajesh
R
Gupta
Rakesh
R
Kapoor
D000328:Adult; D001650:Bile Duct Neoplasms / Q000150:complications / Q000601:surgery*; D002758:Cholangiography / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000191:economics; D049448:Cholangiopancreatography, Magnetic Resonance / Q000009:adverse effects / Q000191:economics; D002761:Cholangitis / Q000139:chemically induced; D002779:Cholestasis / Q000209:etiology / Q000601:surgery*; D003287:Contrast Media / Q000009:adverse effects; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D010969:Plastics; D011446:Prospective Studies; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
D003287:Contrast Media; D008670:Metals; D010969:Plastics