Faculty Collaboration Database

Rate of bilirubin regression after stenting in malignant biliary obstruction for the initiation of chemotherapy: how soon should we repeat endoscopic retrograde cholangiopancreatography? Cancer 2008 Jun;112(11):2417-23

Date

04/12/2008

Pubmed ID

18404695

DOI

10.1002/cncr.23454

Scopus ID

2-s2.0-52049119539 (requires institutional sign-in at Scopus site)   31 Citations

Abstract

BACKGROUND: This study was conducted to evaluate the rate of regression of bilirubin after stent placement for malignant biliary obstruction.

METHODS: Records were reviewed from October 2002 to September 2005 for patients who underwent endoscopic retrograde cholangiopancreatography with stent placement. The time to achieve a bilirubin level <or=2 mg/dL was the primary endpoint because this is the level required by most chemotherapy protocols. Patient variables included type of cancer, liver metastasis, recent chemotherapy, baseline creatinine, and international normalized ratio (INR). Stent variables included type, dimension, stricture location, and sphincterotomy.

RESULTS: In total, 156 patients were included in the analysis: Ninety-three patients achieved a poststent bilirubin level <or=2 mg/dL, 29 patients failed because of stent failure, and 34 patients failed because of inadequate follow-up. The time required for 80% of patients to achieve normalization was more than doubled in those who had prestent bilirubin levels >or=10 mg/dL (6 weeks) compared with those who had prestent bilirubin levels <10 mg/dL (3 weeks). The following variables were identified as statistically significant: prestent bilirubin level, stricture location, liver metastasis, and INR. The cancer type, recent chemotherapy, stent type and diameter, and sphincterotomy were not statistically significant variables.

CONCLUSIONS: The rate of bilirubin normalization after biliary stenting was highly dependent on the prestent bilirubin level. Endoscopic intervention should be considered in patients who fail to achieve adequate normalization of serum bilirubin in 6 weeks if prestent bilirubin level was >or=10 mg/dL and in 3 weeks if their prestent bilirubin level was <10 mg/dL. Independent variables, such as diffuse liver metastases, stricture outside the common bile duct, and elevated INR had predictive value for bilirubin normalization.

Author List

Weston BR, Ross WA, Wolff RA, Evans D, Lee JE, Wang X, Xiao LC, Lee JH

Author

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenocarcinoma
Adult
Aged
Aged, 80 and over
Bilirubin
Cholangiocarcinoma
Cholangiopancreatography, Endoscopic Retrograde
Cholestasis
Female
Gallbladder Neoplasms
Humans
Liver Neoplasms
Male
Middle Aged
Pancreatic Neoplasms
Prognosis
Retrospective Studies
Stents