Introduction
Biliary stenting by endoscopic retrograde cholangiopancreatography (ERCP) is a common palliative endoscopic procedure for unresectable malignant biliary obstruction or for patients unfit for surgery.
Aims & Methods
We conducted a multicentre retrospective cohort study in 3 centres in Portugal, involving patients submitted to first palliative biliary drainage for malignant biliary obstruction by ERCP, between 2015 and 2022. This study aimed to identify predictive factors of 90-day mortality after endobiliary drainage and propose a predictive model. We have analysed data from 217 patients. Statistical analysis was performed using SPSS v.29.
Results
In our cohort, 51,2% (N=111) of patients were female and the mean age was 74 years. 52,5% (N=114) had stage IV disease and in 88% (N=191) the biliary obstruction resulted from primary tumour involvement. The most frequent tumour was primary pancreatic cancer (53,5%, N=116), followed by cholangiocarcinoma (26,7%, N=58). Metallic stents were used in 53,9% (N=117) of the patients, mainly with fully uncovered self-expandable metallic stents (66,7%, N=78). In the multivariate regression model, the independent predictors for 90-day mortality after first ERCP-guided stent placement were primary tumour size <3 cm (p = 0,014; OR 0,394; 95% CI, 0,187-0,830), stage IV malignant disease (p = 0,005; OR 3,776; 95% CI, 1,507-9,465), intrahepatic biliary obstruction (p = 0,004; OR 3,727; 95% CI, 1,518-9,150) and palliative chemotherapy after ERCP biliary drainage (p <0,0001; OR 0,44; 95% CI, 0,015-0,132). Using these variables, we developed a prediction model for the risk of mortality within 90 days after biliary drainage (Hosmer-Lemeshow X2 = 2,907, p = 0,893) with R2 of 44,1% in our cohort. The AUROC for our prediction model was 0,833 (p <0,0001; 95% CI, 0,774-0,892). By the Youden’s J statistic, the optimal cut-off value for was 0,4, with a sensitivity of 73,9% and specificity of 76,3%. Patients with a score < 0,2 had a low likelihood of death, whereas a score ≥ 0,9 had a high likelihood of death.
Conclusion
The present study was able to identify statistically significant predictive factors of 90-day mortality after ERCP-guided biliary stenting in unresectable malignant biliary obstruction, which may help to stratify the risk of death within 90 days post-stent placement. Since all these predictive factors can be determined before ERCP, this risk stratification could help in the definition of the proper palliative strategy for each patient.
References
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Sripongpun, P., Attasaranya, S., Chamroonkul, N., Sookpaisal, T., Khow-Ean, U., Siripun, A., Kongkamol, C., Piratvisuth, T., & Ovartlarnporn, B. (2018). Simple Clinical Score to Predict 24-Week Survival Times in Patients with Inoperable Malignant Distal Biliary Obstruction as a Tool for Selecting Palliative Metallic or Plastic Stents. Journal of gastrointestinal cancer, 49(2), 138–143. https://doi.org/10.1007/s12029-017-9918-9;
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