Does endoscopic retrograde cholangiopancreatography influence the effectiveness of percutaneous transhepatic biliary drainage?

Abstract

Background Endoscopic retrograde cholangiopancreatography (ERCP) is a first-choice diagnostic and treatment procedure for patients with malignant obstructive jaundice. If ERCP is impossible to perform percutaneous transhepatic biliary drainage (PTBD) acts as an alternative method. The aim was to evaluate the effectiveness and the influence of ERCP prior PTBD in the treatment of patients with malignant obstructive jaundice. Methods Retrospective review of patients undergoing PTBD from 2014 to 2015 at the Department of Surgery, Hospital of the Lithuanian University of Health Sciences was performed. Group I - ERCP prior PTBD, Group II – no ERCP prior PTBD. Length of hospital stay, total serum bilirubin values, additional interval procedures, complication and mortality rates were compared. Results Group I consisted of 66 patients and Group II of 48 patients. PTBD significantly reduced total serum bilirubin values in both groups: from 287,87±118,99µmol to 178,35±102,61µmol in Group I (p<0,001) and from 306,83±142,83 µmol to 215,97±127,19 µmol in Group II (p<0,001). However there was no statistically significant difference between total serum bilirubin values, drainage related complication and mortality rates, additional interval procedures. Conclusion ERCP attempt prior PTBD was not associated with serum bilirubin reduction, higher drainage related complication or mortality rates. On the other hand, patients after ERCP, tend to stay longer in hospital, what is associated with higher treatment cost.