Clinical usefulness of endoscopic palliation in patients with biliary obstruction caused by hepatocellular carcinoma.
OBJECTIVE
To evaluate the clinical usefulness of endoscopic biliary drainage (EBD) in patients with hepatocellular carcinoma (HCC).


METHODS
A total of 111 jaundiced patients underwent attempted EBD for relief of HCC-related biliary stricture at our hospital over a 5-year period and all were included in the intention-to-treat (ITT) analysis.


RESULTS
After an endoscopic attempt at drainage, 46 (41.4%) of the 111 patients achieved a favorable response. Biliary cannulation failed in 5 patients. Child-Pugh class C, portal vein thrombosis and severe hyperbilirubinemia were negatively correlated with a favorable EBD response. In the ITT population, 40 (87.0%) of the favorable responders received further treatment for HCC, >2 (3.1%) of the unfavorable responders (p < 0.001). The median survival time for ITT patients with and without a favorable response to EBD was 8.7 and 1.3 months, respectively (p < 0.001). Cox's model showed that a favorable EBD response was an independent predictor of longer survival (hazard ratio 0.20, p < 0.001).


CONCLUSIONS
For HCC patients with tumor-related biliary obstruction, predictors of effective endoscopic palliation of cholestasis were relatively mild hyperbilirubinemia and preserved liver function and intact portal vein flow. A favorable EBD response was associated with longer survival outcomes.
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Jonggi
J
Choi
Ju Hyun
JH
Shim
Do Hyun
DH
Park
Sang Soo
SS
Lee
Dong Wan
DW
Seo
Sung Koo
SK
Lee
Myung-Hwan
MH
Kim
Kang Mo
KM
Kim
Young-Suk
YS
Lim
Young-Hwa
YH
Chung
Yung Sang
YS
Lee
Dong Jin
DJ
Suh
Han Chu
HC
Lee
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000401:mortality / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D002779:Cholestasis / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012189:Retrospective Studies; D017211:Treatment Failure