Introduction
Hilar malignant biliary stricture, caused by malignant tumors, often leads to late diagnosis due to subtle initial symptoms, resulting in poor outcomes. Effective endoscopic interventions significantly improve quality of life and survival, yet often lead to post-operative complications like cholangitis.
Aims & Methods
This study aims to assess the effectiveness and safety of utilizing sequential nasobiliary tube cutting as an alternative to stent placement post-nasobiliary drainage in patients, specifically in mitigating post-operative cholangitis. Additionally, to identify risk factors associated with the development of post-operative cholangitis.
Patients diagnosed at Hangzhou First People's Hospital from January 2015 to January 2023 were divided into nasobiliary tube cutting group and conventional stent group. The former underwent nasobiliary drainage followed by tube cutting when stable, transitioning from external to internal drainage, while the latter received standard stent placement. Statistical analyses compared postoperative cholangitis incidence, drainage success, interventions, complications, and hospital stay, further examining risk factors for postoperative cholangitis.
Results
1. This study encompassed a total of 208 patients, with 103 in the nasobiliary tube cutting group and 105 in the conventional stent group. Postoperative cholangitis occurred in 40 patients, with 12 cases (11.7%) in the nasobiliary tube cutting group and 28 cases (26.7%) in the conventional stent group, showing a statistically significant difference between the two groups (P=0.006). The number of patients whose total bilirubin levels decreased by more than 50% within 7 days postoperatively was 50 (48.5%) in the nasobiliary tube cutting group and 29 (27.6%) in the conventional stent group, a statistically significant difference favoring the nasobiliary tube cutting group (P=0.002). There was no statistically significant difference in the overall drainage success rate between the two groups (P=0.207). Besides postoperative cholangitis, there were no statistically significant differences in other postoperative complications between the two groups (P>0.05). The postoperative hospital stay was longer for patients in the nasobiliary tube cutting group than those in the conventional stent group, with median durations of 10.0 (7.0, 14.0) days versus 7.0 (5.5, 12.5) days, respectively, a difference that was statistically significant (P=0.024).
2. Based on whether postoperative cholangitis occurred, the patients were further categorized into a postoperative cholangitis group (n=40) and a non-postoperative cholangitis group (n=168). Univariate analysis revealed significant differences between the postoperative cholangitis group and the non-postoperative cholangitis group in terms of gender (male), Bismuth-Corlette classification (Type IV), number of ERCP procedures (≥2 times), and re-intervention (P<0.05). Multivariate logistic regression analysis identified Bismuth-Corlette classification (Type IV) (OR=3.207, 95%CI: 1.253-8.210, P=0.015) as an independent risk factor for developing postoperative cholangitis.
Conclusion
For patients with hilar malignant biliary stricture, sequential cutting of nasobiliary tubes as an alternative to stent placement after nasobiliary drainage can reduce the incidence of postoperative cholangitis and achieve early successful drainage, but it results in a prolonged postoperative hospital stay. Bismuth-Corlette classification (Type IV) is an independent risk factor for the development of postoperative cholangitis.
References
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Disclosure
The authors declare that there are no conflicts of interest.