title: Comparison of Adverse Events for Endoscopic vs Percutaneous Biliary Drainage in the Treatment of Malignant Biliary Tract Obstruction in an Inpatient National Cohort.
abstract: OBJECTIVE
  Nonsurgical biliary drainage in malignant biliary tract obstruction can be performed endoscopically by endoscopic retrograde cholangiopancreatography (ERCP) or by percutaneous transhepatic biliary drainage (PTBD). The published body of literature to support either approach is surprisingly sparse, is conflicting on the preferred approach, and is limited by small studies with heterogeneous groups.
  
  
  OBJECTIVE
  To evaluate the procedure-related adverse event rate with endoscopic vs percutaneous drainage in patients with malignant biliary tract obstruction.
  
  
  METHODS
  This was a retrospective analysis from the National Inpatient Sample (NIS) database from 2007 through 2009. Data analysis was performed in 2015. Patients from the NIS database are representative of the US population and are included from both community and tertiary care hospitals in the United States.
  
  
  METHODS
  Procedure-related adverse event rates.
  
  
  RESULTS
  A total of 7445 patients were included for ERCP and 1690 for PTBD. The overall adverse event rate was 8.6% for endoscopic drainage (640 events) and 12.3% for percutaneous biliary drainage (208 events) (P < .001). When analyzed by type of malignant neoplasm, ERCP was associated with a lower rate of adverse events compared with PTBD for pancreatic cancer (2.9% vs 6.2%; odds ratio [OR], 0.46 [95% CI, 0.35-0.61]; P < .001) and cholangiocarcinoma (2.6% vs 4.2% OR, 0.62 [95% CI, 0.35-1.10]; P = .10). For pancreatic cancer, endoscopic procedures were associated with a lower rate of adverse events regardless of the volume of percutaneous procedures performed by a center. For cholangiocarcinoma, centers that performed a low volume of percutaneous biliary drainage procedures were more likely to have adverse events compared with endoscopic procedures performed at the same center (5.7% vs 2.5%; OR, 2.28 [95% CI, 1.02-5.11]; P = .04). In centers that performed a high volume of percutaneous drainage procedures, rates of adverse events were similar to those of endoscopic adverse events (3.5% vs 3.0%; OR, 1.18 [95% CI, 0.53-2.66]; P = .68).
  
  
  CONCLUSIONS
  Our results support the finding that endoscopic biliary drainage for malignant biliary obstruction is a first-line intervention. Endoscopic drainage is superior to percutaneous drainage, in regard to adverse event rate, for patients with pancreatic cancer. For patients with cholangiocarcinoma, endoscopic drainage is superior in centers that perform a low volume of percutaneous biliary drainage procedures.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, North Shore Long Island Jewish Health System, New Hyde Park, New York.
authors.forename: Sumant
authors.initials: S
authors.lastname: Inamdar
authors.affiliation: Department of Preventive Medicine and Nutrition, Columbia University Medical Center, New York, New York.
authors.forename: Eoin
authors.initials: E
authors.lastname: Slattery
authors.affiliation: Division of Gastroenterology, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, North Shore Long Island Jewish Health System, New Hyde Park, New York.
authors.forename: Ramandeep
authors.initials: R
authors.lastname: Bhalla
authors.affiliation: Division of Gastroenterology, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, North Shore Long Island Jewish Health System, New Hyde Park, New York.
authors.forename: Divyesh V
authors.initials: DV
authors.lastname: Sejpal
authors.affiliation: Division of Gastroenterology, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, North Shore Long Island Jewish Health System, New Hyde Park, New York.
authors.forename: Arvind J
authors.initials: AJ
authors.lastname: Trindade
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000628:therapy*; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D016208:Databases, Factual; D004322:Drainage / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States