A Cohort Study Of Drainage-related Cholangitis In Hilar Cholangiocarcinoma

Objective: To investigate the optimal biliary drainage methods for hilar cholangiocarcinoma(HC)type ?,? and ? by observing the occurrence of cholangitis using percutaneous transhepatic biliary drainage(PTBD)and endoscopic retrograde biliary drainage(ERBD)approaches.Design:A total of 180 type ?,? and ? HC patients were enrolled in this prospective cohort study.All patients received biliary drainage managements at The first hospital of Lanzhou University between January 2011 and June 2017,and they were divided into 2 groups,ERCP group(99 patients)and PTBD group(81 patients).(ClinicalTrials registration number: 3104582)Result: Compared with PTBD group,ERCP group yielded higher incidence of cholangitis and pancreatitis,higher cost and salvage biliary drainage rate(P<0.05).No significant difference can be observed between the two groups among all HC type ? patients(P=0.159).Particularly,patients with HC type ? and ? in the ERCP group presented higher incidence of cholangitis than that of the PTBD group(P=0.018).The incidence of cholangitis in subgroups of patients who received endoscopic multi-lateral biliary stents insertion and PTBD in an internal-external ampulla-crossing drainage way was higher than those of endoscopic unilateral biliary stent insertion group and PTBD in a total external drainage(catheter tip above malignant stricture site)way,respectively(50.0% vs 26.5%,and 34.4% vs 14.3%,P<0.05).No significant difference can be observed between endoscopic single biliary stent insertion group and endoscopic nasobiliary drainage group(26.5% vs 26.3%,P>0.05).There was no significant difference in the degree of recent bilirubin reduction between the two groups,namely ERCP group vs PTBD group(P>0.05),endoscopic unilateral biliary stent insertion group vs endoscopic multi-lateral biliary stents insertion(P>0.05),PTBD in a total external drainage vs PTBD in an internal-external ampulla-crossing drainage(P>0.05),endoscopic single biliary stent insertion group vs endoscopic single biliary stent insertion group(P>0.05).Conclusion: For HC type?,? and ?patients,PTBD can lower the cholangitis occurrence,pancreatitis,chance of salvage biliary drainage and hospitalization costs.Notably,the cholangitis rates of type ? and ? patients were both significantly lower in PTBD group.In ERCP group,both endoscopic nasobiliary drainage and endoscopic single biliary stent insertion can reduce theoccurrence of cholangitis,and nasobiliary drainage proves more effective.