Comparative Analysis of External and External-Internal Drainage in Malignant Distal Biliary Obstruction

Introduction. Purpose of the study. To conduct a comparative analysis of external and external-internal biliary drainage for distal malignant biliary obstruction (DMBO).

Research methods. At the Botkin Hospital (Moscow) from 2015 to 2019. We conducted a retrospective analysis of the treatment of patients with PADD, the cause of which was ductal adenocarcinoma of the head of the pancreas. The patients were divided into two groups: G1 – external biliary drainage was performed (n=76), G2 – external-internal biliary drainage (n=94). Characteristics of the groups: age G1 62,3±4,3, G2 63,5±3,9 (p=0,057); gender (m/f) G1 37/41, G2 39/55 (p=0,245); ECOG G1 1,3±0,3, G2 1,4±0,2 (p=0,081); total bilirubin G1 236,2±35,2, G2 228,7±28,5 (p=0,132); alkaline phosphatase G1 658±31,1, G2 649±25,8 (p=0,093); AST G1 216±10,3, G2 213±12,5 (0,086); ALT G1 319±12,2, G2 322±11,5 (p=0,101).

Results. When comparing immediate results, a statistically lower number of Clavien-Dindo complications was revealed in patients with external-internal bile diversion (22,3 % versus 37,2 % (p = 0,043). A qualitative analysis of complications revealed that cholangitis (6,4 %, versus 18,1 %) and post-manipulation pancreatitis (2,6 %, versus 19,1 %) were more common in the group with external-internal bile diversion with statistical significance of the differences (p =0,024 and p=0,001, respectively). Liver failure (26,9 %, versus 13,8 %) and cholangiostomy dislocation (12,8 %, versus 4,2 %) developed more often in the group of patients with external biliary decompression (p=0,036 and p=0,041, respectively). Complications such as biliary peritonitis (6,4 % versus 7,4 %) and acute cholecystitis (5,1 % versus 5,3 %) occurred in both groups without significant differences (p=0,791 and p=0,955, respectively).

Conclusion. External-internal bile diversion is the preferred procedure for DMBO. External bile diversion should be performed according to individual indications.

1. Kurniawan J., Hasan I., Gani R.A. et al. Mortality-related factors in patients with malignant obstructive jaundice. Acta Medica Indonesiana, 2016, vol. 48, рр. 282–288.

2. Perez-Johnston R., Deipolyi A.R., Covey A.M. Percutaneous biliary interventions. Gastroenterology clinics of North America, 2018, vol. 47, № 3, рр. 621–641.

3. Molina H., Chan M.M., Lewandowski R.J., Gabr A., Riaz A. Complications of percutaneous biliary procedures. Seminars in Interventional Radiology, 2021, vol. 38, № 3, рр. 364–372.