title: Clinical outcomes after percutaneous biliary interventions in patients with malignant biliary obstruction caused by metastatic gastric cancer.
abstract: BACKGROUND
  No report has appeared on the histologic characteristics as influencing factors associated with clinical outcomes and survival of patients who underwent percutaneous biliary interventions to treat malignant biliary obstruction caused by metastatic gastric cancer.
  
  
  OBJECTIVE
  To investigate the clinical outcomes after percutaneous biliary interventions in patients with malignant biliary obstruction caused by metastatic gastric cancer and to identify prognostic factors associated with clinical outcomes.
  
  
  METHODS
  We retrospectively assessed 117 patients who underwent percutaneous transhepatic biliary drainage (PTBD) between January 2005 and December 2009, for treatment of malignant biliary obstructions caused by metastatic gastric cancer. Of these 117 patients, 54 subsequently underwent metallic stent placement.
  
  
  RESULTS
  The technical success rates of PTBD and metallic stent placement were 100% and 100%, respectively. Self-limiting hemobilia after PTBD occurred in eight (7%) patients, and self-limiting hemobilia (n = 4) and acute pancreatitis (n = 3) after stent placement occurred in seven (13%) patients. Successful drainage was achieved in 105 (90%) of the 117 patients who underwent PTBD and in 49 (91%) of 54 patients who underwent metallic stent placement. Multiple Cox's regression analysis showed that the histology of primary gastric cancer (P = 0.011), serum bilirubin after PTBD (P = 0.002) and stenting (P = 0.017), and chemotherapy after PTBD (P < 0.001) and stenting (P = 0.033) were independent predictors of survival.
  
  
  CONCLUSIONS
  PTBD and subsequent metallic stent placement were safe and effective methods for palliative treatment in patients with malignant biliary obstruction caused by metastatic gastric cancer. Patients with a differentiated histology of primary gastric cancer and serum bilirubin level ≤2 mg/dl after PTBD are probably the best candidates for treatment with a combination of metallic stent placement and chemotherapy.
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. radgwon@amc.seoul.kr
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Gwon
authors.forename: Gi-Young
authors.initials: GY
authors.lastname: Ko
authors.forename: Kyu-Bo
authors.initials: KB
authors.lastname: Sung
authors.forename: Hyun-Ki
authors.initials: HK
authors.lastname: Yoon
authors.forename: Kyung-Ah
authors.initials: KA
authors.lastname: Kim
authors.forename: Young Jun
authors.initials: YJ
authors.lastname: Kim
authors.forename: Tae Hwan
authors.initials: TH
authors.lastname: Kim
authors.forename: Woong Hee
authors.initials: WH
authors.lastname: Lee
mesh_terms: D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D002758:Cholangiography; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D003251:Constriction, Pathologic; D003287:Contrast Media; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015607:Stents; D013274:Stomach Neoplasms / Q000473:pathology*; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media