Interventional Treatment of Malignant Biliary Obstruction: Is It Time to Change the Paradigm?

Hristov, Bozhidar; Doykov, Daniel; Andonov, Vladimir; Doykov, Mladen; Kraev, Krasimir; Uchikov, Petar; Dimov, Rosen; Kostov, Gancho; Valova, Siyana; Doykova, Katya; Chakarov, Dzhevdet; Sandeva, Milena

doi:10.3390/gastroent15020020

Open AccessArticle

Interventional Treatment of Malignant Biliary Obstruction: Is It Time to Change the Paradigm?

by

Bozhidar Hristov

^1,2,*

,

Daniel Doykov

^1,2

,

Vladimir Andonov

^1,2,

Mladen Doykov

^3,4

,

Krasimir Kraev

^5,6

,

Petar Uchikov

^7,8,

Rosen Dimov

^7,9,

Gancho Kostov

^7,9

,

Siyana Valova

^10,11,

Katya Doykova

^12,13

,

Dzhevdet Chakarov

^14,15 and

Milena Sandeva

¹⁶

¹

Section “Gastroenterology”, Second Department of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria

²

Gastroenterology Clinic, University Hospital “Kaspela”, 4001 Plovdiv, Bulgaria

³

Department of Urology and General Medicine, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria

⁴

Clinic of Urology, University Hospital “Kaspela”, 4001 Plovdiv, Bulgaria

⁵

Department of Propedeutics of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria

⁶

Rheumatology Clinic, St. George University Hospital, 6000 Plovdiv, Bulgaria

⁷

Department of Special Surgery, Faculty of Medicine, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria

⁸

Second Department of Surgery, St. George University Hospital, 4000 Plovdiv, Bulgaria

⁹

Department of Surgery, University Hospital “Kaspela”, 4001 Plovdiv, Bulgaria

¹⁰

Section “Nephrology”, Second Department of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria

¹¹

Clinic of Nephrology, University Hospital “Kaspela”, 4001 Plovdiv, Bulgaria

¹²

Department of Diagnostic Imaging, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria

¹³

Department of Diagnostic Imaging, University Hospital “Kaspela”, 4001 Plovdiv, Bulgaria

¹⁴

Section of General Surgery, Department of Propedeutics of Surgical Diseases, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria

¹⁵

First Clinic of Surgery, St. George University Hospital, 4000 Plovdiv, Bulgaria

¹⁶

Department of Midwifery, Faculty of Public Health, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria

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Author to whom correspondence should be addressed.

Gastroenterol. Insights 2024, 15(2), 266-284; https://doi.org/10.3390/gastroent15020020

Submission received: 18 February 2024 / Revised: 29 March 2024 / Accepted: 2 April 2024 / Published: 8 April 2024

(This article belongs to the Section Biliary Content)

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Abstract

Introduction. Biliary obstruction is a common manifestation of biliopancreatic malignancies, and its relief is an essential part of the treatment algorithm. Currently, there are three techniques to manage malignant biliary obstruction—endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic biliary drainage (PTBD), and endoscopic ultrasound-guided biliary drainage (EUS-BD). ERCP has been adopted as a first-line treatment modality but EUS-BD is gradually emerging as a viable alternative. The aim of the current article is to assess the clinical outcomes of the three nonsurgical biliary drainage procedures. Materials and methods. A total of 102 consecutive patients with unresectable biliopancreatic malignancy inducing biliary obstruction and subjected to palliative treatment by means of ERCP, EUS-BD, or PTBD were retrospectively included in the study. Results. No difference in clinical and technical success of the procedures was found: ERCP—97.2% technical; 88.9% clinical; PTBD—94.4% technical, 72.2% clinical; EUS-BD—90% technical; 83.3% clinical. Adverse events (AEs) and reinterventions were significantly more common in PTBD (38.9% and 52.8%) and ERCP (27.9% and 25%) compared to EUS-BD (10% and 3.3%). Total duration of hospital stay and number of hospitalizations were lower in the EUS-BD compared to PTBD and ERCP groups. Conclusions. In the presence of adequate expertise, EUS-BD may be superior to PTBD and ERCP in achieving and sustaining biliary drainage in the setting of unresectable malignancy.

Keywords: biliary; cholangiopancreaotography; drainage; endoscopy; obstructive jaundice; percutaneous; ultrasound

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MDPI and ACS Style

Hristov, B.; Doykov, D.; Andonov, V.; Doykov, M.; Kraev, K.; Uchikov, P.; Dimov, R.; Kostov, G.; Valova, S.; Doykova, K.; et al. Interventional Treatment of Malignant Biliary Obstruction: Is It Time to Change the Paradigm? Gastroenterol. Insights 2024, 15, 266-284. https://doi.org/10.3390/gastroent15020020

AMA Style

Hristov B, Doykov D, Andonov V, Doykov M, Kraev K, Uchikov P, Dimov R, Kostov G, Valova S, Doykova K, et al. Interventional Treatment of Malignant Biliary Obstruction: Is It Time to Change the Paradigm? Gastroenterology Insights. 2024; 15(2):266-284. https://doi.org/10.3390/gastroent15020020

Chicago/Turabian Style

Hristov, Bozhidar, Daniel Doykov, Vladimir Andonov, Mladen Doykov, Krasimir Kraev, Petar Uchikov, Rosen Dimov, Gancho Kostov, Siyana Valova, Katya Doykova, and et al. 2024. "Interventional Treatment of Malignant Biliary Obstruction: Is It Time to Change the Paradigm?" Gastroenterology Insights 15, no. 2: 266-284. https://doi.org/10.3390/gastroent15020020

APA Style

Hristov, B., Doykov, D., Andonov, V., Doykov, M., Kraev, K., Uchikov, P., Dimov, R., Kostov, G., Valova, S., Doykova, K., Chakarov, D., & Sandeva, M. (2024). Interventional Treatment of Malignant Biliary Obstruction: Is It Time to Change the Paradigm? Gastroenterology Insights, 15(2), 266-284. https://doi.org/10.3390/gastroent15020020

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Interventional Treatment of Malignant Biliary Obstruction: Is It Time to Change the Paradigm?

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