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

• Type of Material: Article
• Authors: Field Willingham, Emory University; Joseph B Elmunzer, Medical University of South Carolina; Zachary L Smith, Case Western Reserve University; Paul Tarnasky, Methodist Dallas Medical Center; Andrew Y Wang, University of Virginia; Patrick Yachimski, Vanderbilt University; Filip Banovac, Vanderbilt University; Jonathan M Buscaglia, SUNY Stony Brook; James Buxbaum, University of Southern California; Amitabh Chak, Case Western Reserve University; Bradford Chong, University of Southern California; Gregory A Cote, Medical University of South Carolina; Peter V Draganov, University of Florida; Kulwinder Dua, Medical College of Wisconsin; Valerie Durkalski, Medical University of South Carolina; Brian S Geller, University of Florida; Laith H Jamil, Cedars Sinai Medical Center; Rajesh N Keswani, Northwestern University; Mouen A Khashab, Johns Hopkins Medical Institutions; Ryan Law, University of Michigan; Simon K Lo, Cedars Sinai Med Ctr; Sean McCarthy, Ohio State University; Bayne J Selby, Medical University of South Carolina; Vikesh K Singh, Johns Hopkins Medical Institutions; Jason R Taylor, St Louis University; Rebecca L Spitzer, Medical University of South Carolina; Lydia D Foster, Medical University of South Carolina
• Language: English
• Date: 2021-05-08
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 by the AGA Institute
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.cgh.2020.05.035
• Title of Journal or Parent Work: CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
• Volume: 19
• Issue: 6
• Start Page: 1282
• End Page: 1284
• Keywords: Gastroenterology & Hepatology; CHOLANGIOCARCINOMA; Science & Technology; Life Sciences & Biomedicine; PREOPERATIVE BILIARY DRAINAGE

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).