Endoscopic biliary drainage leads to high technical success rate in HCC

Clinicians may be able to safely perform endoscopic biliary drainage for patients with hepatocellular carcinoma with jaundice and liver dysfunction with a high technical success rate, according to a study in BMC Gastroenterology.

“[Child–Pugh] class C is an important predictor of the effectiveness of endoscopic biliary drainage in HCC patients with liver dysfunction with or without cholangitis,” Akihiro Matsumi, MD, from the department of gastroenterology and hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, and colleagues wrote. “When clinical success is achieved, the prognosis is improved; therefore, we should actively promote biliary drainage for HCC jaundice.”

They added, “Clinical success may extend the survival duration, even in patients expected to have a poor prognosis.”

Matsumi and colleagues performed a retrospective study of 107 patients with hepatocellular carcinoma who received endoscopic biliary drainage for jaundice and liver dysfunction. Patients were evaluated for technical and clinical success rate, complications, factors correlated with clinical failure and survival duration.

Results showed 105 of 107 patients achieved technical success and of these, 85 patients achieved clinical success. Investigators reported complications in three patients related to endoscopic retrograde cholangiography.

“Child–Pugh class C (odds ratio 3.9, 95% confidence interval [CI] 1.47–10.4, P = .0046) was the only factor associated with clinical failure, irrespective of successful drainage,” investigators wrote.

According to researchers, the median survival duration was significantly longer in patients with clinical success compared with patients without clinical success (5 months vs. 0.93 months; HR = 3.2; 95% CI, 1.87–5.37). Factors correlated with long-term survival were HCC stage I/II/III (HR = 0.57; 95% CI, 0.34–0.95), absence of portal thrombosis (HR = 0.52; 95% CI, 0.32–0.85) and clinical success (HR = 0.39; 95% CI, 0.21–0.7).