An Unsuccessful Randomized Trial of Percutaneous vs Endoscopic Drainage of Suspected Malignant Hilar Obstruction.

Abstract

Percutaneous transhepatic biliary drainage (PTBD) and endoscopic retrograde cholangiopancreatography (ERCP) are widely accepted but competing approaches for the management of malignant obstruction at the hilum of the liver. ERCP is favored in the United States on the basis of high success rates for non-hilar indications, the perceived safety and superior tissue sampling capability of ERCP relative to PTBD, and the avoidance of external drains that are undesirable to patients. A recent randomized controlled trial (RCT) comparing the 2 modalities in patients with resectable hilar cholangiocarcinoma was terminated prematurely because of higher mortality in the PTBD group.1 In contrast, most observational data suggest that PTBD is superior for achieving complete drainage.2-6 Because the preferred procedure remains uncertain, we aimed to compare PTBD and ERCP as the primary intervention in patients with cholestasis due to malignant hilar obstruction (MHO).

• Authors: B Joseph Elmunzer, Zachary L Smith, Paul Tarnasky, Andrew Y Wang, Patrick Yachimski, Filip Banovac, Jonathan M Buscaglia, James Buxbaum, Amitabh Chak, Bradford Chong, Gregory A Coté, Peter V Draganov, Kulwinder Dua, Valerie Durkalski, Brian S Geller, Laith H Jamil, Rajesh N Keswani, Mouen A Khashab, Ryan Law, Simon K Lo, Sean McCarthy, J Bayne Selby, Vikesh K Singh, Jason R Taylor, Field F Willingham, Rebecca L Spitzer, Lydia D Foster, INTERCPT study group and the United States Cooperative for Outcomes Research in Endoscopy (USCORE)
• Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (Clin Gastroenterol Hepatol) Vol. 19 Issue 6 Pg. 1282-1284 (06 2021) ISSN: 1542-7714 [Electronic] United States
• PMID: 32454259 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2021 AGA Institute. Published by Elsevier Inc. All rights reserved.

Topics

• Bile Duct Neoplasms (complications)
• Bile Ducts, Intrahepatic
• Cholangiopancreatography, Endoscopic Retrograde
• Cholestasis (surgery)
• Drainage
• Endosonography
• Humans