title: Evaluation of endoscopic biliary stenting for obstructive jaundice caused by hepatocellular carcinoma.
abstract: OBJECTIVE
  To review the usefulness of endoscopic biliary stenting for obstructive jaundice caused by hepatocellular carcinoma and identify problems that may need to be addressed.
  
  
  METHODS
  The study population consisted of 36 patients with obstructive jaundice caused by hepatocellular carcinoma (HCC) who underwent endoscopic biliary stenting (EBS) as the initial drainage procedure at our hospital. The EBS technical success rate and drainage success rate were assessed. Drainage was considered effective when the serum total bilirubin level decreased by 50% or more following the procedure compared to the pre-drainage value. Survival time after the procedure and patient background characteristics were assessed comparatively between the successful drainage group (group A) and the non-successful drainage group (group B). The EBS stent patency duration in the successful drainage group (group A) was also assessed.
  
  
  RESULTS
  The technical success rate was 100% for both the initial endoscopic nasobiliary drainage and EBS in all patients. Single stenting was placed in 21 patients and multiple stenting in the remaining 15 patients. The drainage successful rate was 75% and the median interval to successful drainage was 40 d (2-295 d). The median survival time was 150 d in group A and 22 d in group B, with the difference between the two groups being statistically significant (P < 0.0001). There were no statistically significant differences between the two groups with respect to patient background characteristics, background liver condition, or tumor factors; on the other hand, the two groups showed statistically significant differences in patients without a history of hepatectomy (P = 0.009) and those that received multiple stenting (P = 0.036). The median duration of stent patency was 43 d in group A (2-757 d). No early complications related to the EBS technique were encountered. Late complications occurred in 13 patients (36.1%), including stent occlusion in 7, infection in 3, and distal migration in 3.
  
  
  CONCLUSIONS
  EBS is recommended as the initial drainage procedure for obstructive jaundice caused by HCC, as it appears to contribute to prolongation of survival time.
authors.affiliation: Gen Sugiyama, Yoshinobu Okabe, Yusuke Ishida, Fumihiko Saitou, Ryuichi Kawahara, Hiroto Ishikawa, Hiroyuki Horiuchi, Hisafumi Kinoshita, Osamu Tsuruta, Michio Sata, Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan.
authors.forename: Gen
authors.initials: G
authors.lastname: Sugiyama
authors.affiliation: Gen Sugiyama, Yoshinobu Okabe, Yusuke Ishida, Fumihiko Saitou, Ryuichi Kawahara, Hiroto Ishikawa, Hiroyuki Horiuchi, Hisafumi Kinoshita, Osamu Tsuruta, Michio Sata, Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Okabe
authors.affiliation: Gen Sugiyama, Yoshinobu Okabe, Yusuke Ishida, Fumihiko Saitou, Ryuichi Kawahara, Hiroto Ishikawa, Hiroyuki Horiuchi, Hisafumi Kinoshita, Osamu Tsuruta, Michio Sata, Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Ishida
authors.affiliation: Gen Sugiyama, Yoshinobu Okabe, Yusuke Ishida, Fumihiko Saitou, Ryuichi Kawahara, Hiroto Ishikawa, Hiroyuki Horiuchi, Hisafumi Kinoshita, Osamu Tsuruta, Michio Sata, Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan.
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Saitou
authors.affiliation: Gen Sugiyama, Yoshinobu Okabe, Yusuke Ishida, Fumihiko Saitou, Ryuichi Kawahara, Hiroto Ishikawa, Hiroyuki Horiuchi, Hisafumi Kinoshita, Osamu Tsuruta, Michio Sata, Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan.
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Kawahara
authors.affiliation: Gen Sugiyama, Yoshinobu Okabe, Yusuke Ishida, Fumihiko Saitou, Ryuichi Kawahara, Hiroto Ishikawa, Hiroyuki Horiuchi, Hisafumi Kinoshita, Osamu Tsuruta, Michio Sata, Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Ishikawa
authors.affiliation: Gen Sugiyama, Yoshinobu Okabe, Yusuke Ishida, Fumihiko Saitou, Ryuichi Kawahara, Hiroto Ishikawa, Hiroyuki Horiuchi, Hisafumi Kinoshita, Osamu Tsuruta, Michio Sata, Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Horiuchi
authors.affiliation: Gen Sugiyama, Yoshinobu Okabe, Yusuke Ishida, Fumihiko Saitou, Ryuichi Kawahara, Hiroto Ishikawa, Hiroyuki Horiuchi, Hisafumi Kinoshita, Osamu Tsuruta, Michio Sata, Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan.
authors.forename: Hisafumi
authors.initials: H
authors.lastname: Kinoshita
authors.affiliation: Gen Sugiyama, Yoshinobu Okabe, Yusuke Ishida, Fumihiko Saitou, Ryuichi Kawahara, Hiroto Ishikawa, Hiroyuki Horiuchi, Hisafumi Kinoshita, Osamu Tsuruta, Michio Sata, Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Tsuruta
authors.affiliation: Gen Sugiyama, Yoshinobu Okabe, Yusuke Ishida, Fumihiko Saitou, Ryuichi Kawahara, Hiroto Ishikawa, Hiroyuki Horiuchi, Hisafumi Kinoshita, Osamu Tsuruta, Michio Sata, Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan.
authors.forename: Michio
authors.initials: M
authors.lastname: Sata
mesh_terms: D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000401:mortality; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001663:Bilirubin
keywords: Biliary drainage; Endoscopic biliary stenting; Hepatocellular carcinoma; Obstructive jaundice; Percutaneous transhepatic biliary drainage