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PLoS One. 2017 Nov 2;12(11):e0187469. doi: 10.1371/journal.pone.0187469. eCollection 2017.

Role of endoscopic biliary drainage in advanced hepatocellular carcinoma with jaundice.

Author information

1
Department of Internal Medicine, College of Medicine and Medical Research Institute, Pusan National University, Pusan National University Hospital, Busan, Republic of Korea.
2
Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
3
BIO-IT Foundry Technology Institute, Pusan National University, Busan, Republic of Korea.
4
Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
5
Department of Radiology, College of Medicine and Medical Research Institute, Pusan National University, Pusan National University Hospital, Busan, Republic of Korea.

Abstract

BACKGROUND:

Patients with advanced hepatocellular carcinoma (HCC) with jaundice have an extremely poor prognosis. Although biliary drainage can resolve obstructive jaundice, signs of obstruction may not be evident. This study evaluated the role of endoscopic biliary drainage in patients with advanced HCC and obstructive jaundice.

METHODS:

From 2010 to 2015, 74 patients underwent endoscopic biliary drainage for obstructive jaundice due to advanced HCC. Jaundice resolution was defined as complete response and total bilirubin concentration below 3 mg/dl.

RESULTS:

The technical success rate in the 74 patients was 92.1% (70/76). Of the 70 patients who underwent successful biliary drainage, 48 (68.6%) and 22 (31.4%) were Child-Pugh classes B and C, respectively, and 10 (14.3%) and 60 (85.7%) were BCLC stages B and C, respectively. Intrahepatic bile duct (IHD) dilatation was observed in 35 patients (50%). After drainage, the complete response rate was 35.7% (25/70). The mean time to resolution was 17.4 ±8.5 days. However, jaundice was re-aggravated in 74.3% (15/25) after a mean 103.5 ±96.4 days. Multivariate analysis showed that the absence of ascites, presence of IHD dilatation, normal range of prothrombin time, and lower MELD score were significantly associated with complete response. The overall survival rate was 15.7% (11/70) and the median survival time is 28 days (95% confidence interval 2.6-563 days). Complete response and HCC treatment after drainage were significantly associated with survival.

CONCLUSION:

Effective endoscopic biliary drainage is an important palliative treatment in patients with advanced HCC and obstructive jaundice, especially those with IHD dilatation and preserved liver function, as determined by ascites, prothrombin time, and MELD score.

PMID:
29095941
PMCID:
PMC5667855
DOI:
10.1371/journal.pone.0187469
[Indexed for MEDLINE]
Free PMC Article

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