title: Biliary drainage for obstructive jaundice caused by unresectable hepatocellular carcinoma: the endoscopic versus percutaneous approach.
abstract: BACKGROUND
  For palliative treatment of the obstructive jaundice associated with unresectable hepatocellular carcinoma (HCC), percutaneous transhepatic biliary drainage (PTBD) or endoscopic retrograde biliary drainage (ERBD) has been performed. PTBD is preferred as an initial procedure. Little is known about the better option for patients with obstructive jaundice caused by unresectable HCC.
  
  
  METHODS
  Sixty patients who had received ERBD or PTBD for the palliative treatment of obstructive jaundice caused by unresectable HCC between January 2006 and May 2010 were included in this retrospective study. Successful drainage, drainage patency, and the overall survival of patients were evaluated.
  
  
  RESULTS
  Univariate analysis revealed that the overall frequency of successful drainage was higher in the ERBD group (22/29, 75.9%) than in the PTBD group (15/31, 48.4%) (P=0.029); but multivariate analysis showed marginal significance (P=0.057). The duration of drainage patency was longer in the ERBD group than in the PTBD group (82 vs 37 days, respectively, P=0.020). Regardless of what procedure was performed, the median survival time of patients who had a successful drainage was much longer than that of the patients who did not have a successful drainage (143 vs 38 days, respectively, P<0.001).
  
  
  CONCLUSIONS
  Besides PTBD, ERBD may be used as the initial treatment option to improve obstructive jaundice in patients with unresectable HCC if there is a longer duration of drainage patency after a successful drainage.
authors.affiliation: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jongkyoung
authors.initials: J
authors.lastname: Choi
authors.forename: Ji Kon
authors.initials: JK
authors.lastname: Ryu
authors.forename: Sang Hyub
authors.initials: SH
authors.lastname: Lee
authors.forename: Dong-Won
authors.initials: DW
authors.lastname: Ahn
authors.forename: Jin-Hyeok
authors.initials: JH
authors.lastname: Hwang
authors.forename: Yong-Tae
authors.initials: YT
authors.lastname: Kim
authors.forename: Yong Bum
authors.initials: YB
authors.lastname: Yoon
authors.forename: Joon Koo
authors.initials: JK
authors.lastname: Han
mesh_terms: D000368:Aged; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects; D006528:Carcinoma, Hepatocellular / Q000150:complications*; D016009:Chi-Square Distribution; D004322:Drainage / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000009:adverse effects; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome