EFFECTS OF ENDOSCOPIC BILIARY DRAINAGE ON PROXIMAL AND DISTAL MALIGNANT BILIARY OBSTRUCTIONS

BUGRA TOLGA KONDUK¹, TALHA YILDIZ¹, SENIZ DEMIRYUREK², ABDULLAH EMRE YILDIRIM¹, SEZGIN BARUTCU¹, RAMAZAN ERDEM ER¹, AYHAN BALKAN¹, MURAT TANER GULSEN¹

¹Department of Gastroenterology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey - ²Department of Physiology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey

Introduction: Biliary stent placement is the treatment of choice for malignant biliary obstruction caused by unresectable carcino- mas. The purpose of this study was to compare the type of obstructions, changes in biochemical parameters before and after endoscopic retrograde cholangiopancreatography (ERCP), complications, and mortality rate of patients with proximal biliary obstructions with those of patients with distal biliary obstructions.

Material and method: A total of 161 patients (102 men and 59 women) with inoperable malignant biliary obstructions were analyzed retrospectively. ERCP was performed on all patients.

Results: Cholangiocarcinomas and pancreatic carcinomas were the most frequent tumor for the proximal and distal stenosis groups, respectively. There were marked decreases in serum total bilirubin, direct bilirubin, gamma glutamyltransferase, alkaline pho- sphatase, alanine aminotransferase, and aspartate aminotransferase levels after ERCP (all P<0.001). A total of 71 (44.1%) patients developed complications. Frequency of complications was significantly high in the proximal stenosis group (57.4%) when compared to the distal stenosis group (37.4%, P=0.025). The percentage of the patients receiving percutaneous transhepatic biliary drainage inter- vention following ERCP failure was markedly higher in the proximal stenosis group (33.3%) than the distal stenosis group (9.3%, P<0.001). There was also high mortality rate in the proximal stenosis group (27.8% vs. 12.1%, P<0.020).

Conclusion: Stent placement is a feasible and palliative method for unresectable malignant biliary obstruction. Our results show that endoscopic biliary drainage was more effective with low complication rate for the distal malignant biliary obstructions than for the proximal biliary stenoses.