title: The efficacy of endoscopic palliation of obstructive jaundice in hepatocellular carcinoma.
abstract: OBJECTIVE
  Obstructive jaundice in patients with hepatocellular carcinoma (HCC) is uncommon (0.5-13%). Unlike other causes of obstructive jaundice, the role of endoscopic intervention in obstructive jaundice complicated by HCC has not been clearly defined. The aim of this study was to evaluate the clinical characteristics of obstructive jaundice caused by HCC and predictive factors for successful endoscopic intervention.
  
  
  METHODS
  From 1999 to 2009, 54 patients with HCC who underwent endoscopic intervention to relieve obstructive jaundice were included. We defined endoscopic intervention as a clinical success when the obstructive jaundice was relieved within 4 weeks.
  
  
  RESULTS
  Clinical success was achieved in 23 patients (42.6%). Patients in the clinical success group showed better Child-Pugh liver function (C-P grade A or B/C; 17/6 vs. 8/20), lower total bilirubin levels (8.1±5.3 mg/dL vs. 23.1±10.4 mg/dL) prior to the treatment, and no history of alcohol consumption. The only factor predictive of clinical success by multivariate analysis was low total bilirubin level at the time of endoscopic intervention, regardless of history of alcohol consumption [odds ratio 1.223 (95% confidence interval, 1.071-1.396), p=0.003]. The cut-off value of pre-endoscopic treatment total bilirubin level was 12.8 mg/dL for predicting the clinical prognosis. Median survival after endoscopic intervention in the clinical success group was notably longer than that in the clinical failure group (5.6 months vs. 1.5 months, p≤0.001).
  
  
  CONCLUSIONS
  Before endoscopic intervention, liver function, especially total bilirubin level, should be checked to achieve the best clinical outcome. Endoscopic intervention can be helpful to relieve jaundice in well selected patients with HCC.
authors.affiliation: Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, Seoul, Korea. ; Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Semi
authors.initials: S
authors.lastname: Park
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jeong Youp
authors.initials: JY
authors.lastname: Park
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Moon Jae
authors.initials: MJ
authors.lastname: Chung
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jae Bock
authors.initials: JB
authors.lastname: Chung
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Seung Woo
authors.initials: SW
authors.lastname: Park
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kwang-Hyub
authors.initials: KH
authors.lastname: Han
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea. ; Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Si Young
authors.initials: SY
authors.lastname: Song
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea. bang7028@yuhs.ac.
authors.forename: Seungmin
authors.initials: S
authors.lastname: Bang
mesh_terms: D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000150:complications*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000150:complications / Q000601:surgery*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010166:Palliative Care; D016896:Treatment Outcome
chemical_list: D001663:Bilirubin
keywords: Hepatocellular carcinoma; endoscopic retrograde cholangiopancreatography; obstructive jaundice; palliative treatment