title: Multicenter study of endoscopic preoperative biliary drainage for malignant distal biliary obstruction.
abstract: OBJECTIVE
  To determine the optimal method of endoscopic preoperative biliary drainage for malignant distal biliary obstruction.
  
  
  METHODS
  Multicenter retrospective study was conducted in patients who underwent plastic stent (PS) or nasobiliary catheter (NBC) placement for resectable malignant distal biliary obstruction followed by surgery between January 2010 and March 2012. Procedure-related adverse events, stent/catheter dysfunction (occlusion or migration of PS/NBC, development of cholangitis, or other conditions that required repeat endoscopic biliary intervention), and jaundice resolution (bilirubin level < 3.0 mg/dL) were evaluated. Cumulative incidence of jaundice resolution and dysfunction of PS/NBC were estimated using competing risk analysis. Patient characteristics and preoperative biliary drainage were also evaluated for association with the time to jaundice resolution and PS/NBC dysfunction using competing risk regression analysis.
  
  
  RESULTS
  In total, 419 patients were included in the study (PS, 253 and NBC, 166). Primary cancers included pancreatic cancer in 194 patients (46%), bile duct cancer in 172 (41%), gallbladder cancer in three (1%), and ampullary cancer in 50 (12%). The median serum total bilirubin was 7.8 mg/dL and 324 patients (77%) had ≥ 3.0 mg/dL. During the median time to surgery of 29 d [interquartile range (IQR), 30-39 d]. PS/NBC dysfunction rate was 35% for PS and 18% for NBC [Subdistribution hazard ratio (SHR) = 4.76; 95%CI: 2.44-10.0, P < 0.001]; the pig-tailed tip was a risk factor for PS dysfunction. Jaundice resolution was achieved in 85% of patients and did not depend on the drainage method (PS or NBC).
  
  
  CONCLUSIONS
  PS has insufficient patency for preoperative biliary drainage. Given the drawbacks of external drainage via NBC, an alternative method of internal drainage should be explored.
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Sasahira
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Hamada
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Togawa
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Yamamoto
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Iwai
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Kiichi
authors.initials: K
authors.lastname: Tamada
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kawaguchi
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Shimura
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Takero
authors.initials: T
authors.lastname: Koike
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Yoshida
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sugimori
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Shomei
authors.initials: S
authors.lastname: Ryozawa
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Kakimoto
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Ko
authors.initials: K
authors.lastname: Nishikawa
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Kitamura
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Tsunao
authors.initials: T
authors.lastname: Imamura
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Mizuide
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Toda
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Iruru
authors.initials: I
authors.lastname: Maetani
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Sakai
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Nagahama
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nakai
authors.affiliation: Naoki Sasahira, Department of Gastroenterology, JCHO Tokyo Takanawa Hospital, Tokyo 108-8606, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
mesh_terms: D000368:Aged; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D057785:Catheters; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D004067:Digestive System Neoplasms / Q000150:complications*; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007564:Japan; D041781:Jaundice, Obstructive / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: Endoscopic preoperative biliary drainage; Malignant distal biliary obstruction; Nasobiliary drainage; Periampullary cancer; Plastic stent