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Endoscopic or percutaneous biliary drainage for gallbladder cancer: a randomized trial and quality of life assessment.
Clin Gastroenterol Hepatol. 2008 Aug; 6(8):944-950.e3.CG

Abstract

BACKGROUND & AIMS

Patients with carcinoma of the gallbladder (GBC) and obstructive jaundice are usually not amenable to curative resection. Effective palliation by biliary decompression is the goal of treatment. Endoscopic stenting (ES) and percutaneous transhepatic biliary drainage (PTBD) can provide biliary decompression. We compared unilateral PTBD and ES in patients with a hilar block caused by GBC and assessed their quality of life (QOL).

METHODS

Consecutive patients with GBC not suitable for curative resection with Bismuth type 2 or 3 block were randomized to either PTBD or ES with a 10F plastic stent. Technical success, successful drainage, early cholangitis, complications, procedure-related mortality, 30-day mortality, survival, and QOL before and 1 and 3 months after stenting were compared between the 2 groups. All patients were followed up until death.

RESULTS

Fifty-four patients were randomized to PTBD or ES (27 each). Successful drainage was better in the PTBD group (89% vs 41%; P < .001). Early cholangitis was significantly higher in the ES group (48% vs 11%; P = .002). Procedure-related (4% vs 8%) and 30-day mortality (4% vs 8%) and median survival were similar (60 days in both; P = .71). Although the World Health Organization-Quality of Life 1- and 3-month physical and psychological scores were better after PTBD, the difference was not significant. The European Organization for Research and Treatment of Cancer (EORTC)-Quality of Life Questionnaire 30 global health status at 3 months was significantly better after PTBD (75 vs 30.5, P = .02). The EORTC symptom scores improved in both groups, but only fatigue was significantly better after PTBD.

CONCLUSIONS

PTBD provides better biliary drainage and has lower complication rates in patients with GBC and hilar block.

Authors+Show Affiliations

Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

18585976

Citation

Saluja, Sundeep Singh, et al. "Endoscopic or Percutaneous Biliary Drainage for Gallbladder Cancer: a Randomized Trial and Quality of Life Assessment." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, vol. 6, no. 8, 2008, pp. 944-950.e3.
Saluja SS, Gulati M, Garg PK, et al. Endoscopic or percutaneous biliary drainage for gallbladder cancer: a randomized trial and quality of life assessment. Clin Gastroenterol Hepatol. 2008;6(8):944-950.e3.
Saluja, S. S., Gulati, M., Garg, P. K., Pal, H., Pal, S., Sahni, P., & Chattopadhyay, T. K. (2008). Endoscopic or percutaneous biliary drainage for gallbladder cancer: a randomized trial and quality of life assessment. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 6(8), 944-e3. https://doi.org/10.1016/j.cgh.2008.03.028
Saluja SS, et al. Endoscopic or Percutaneous Biliary Drainage for Gallbladder Cancer: a Randomized Trial and Quality of Life Assessment. Clin Gastroenterol Hepatol. 2008;6(8):944-950.e3. PubMed PMID: 18585976.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic or percutaneous biliary drainage for gallbladder cancer: a randomized trial and quality of life assessment. AU - Saluja,Sundeep Singh, AU - Gulati,Manpreet, AU - Garg,Pramod Kumar, AU - Pal,Hemraj, AU - Pal,Sujoy, AU - Sahni,Peush, AU - Chattopadhyay,Tushar K, Y1 - 2008/06/30/ PY - 2007/08/15/received PY - 2008/02/24/revised PY - 2008/03/27/accepted PY - 2008/7/1/pubmed PY - 2008/10/24/medline PY - 2008/7/1/entrez SP - 944 EP - 950.e3 JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin. Gastroenterol. Hepatol. VL - 6 IS - 8 N2 - BACKGROUND & AIMS: Patients with carcinoma of the gallbladder (GBC) and obstructive jaundice are usually not amenable to curative resection. Effective palliation by biliary decompression is the goal of treatment. Endoscopic stenting (ES) and percutaneous transhepatic biliary drainage (PTBD) can provide biliary decompression. We compared unilateral PTBD and ES in patients with a hilar block caused by GBC and assessed their quality of life (QOL). METHODS: Consecutive patients with GBC not suitable for curative resection with Bismuth type 2 or 3 block were randomized to either PTBD or ES with a 10F plastic stent. Technical success, successful drainage, early cholangitis, complications, procedure-related mortality, 30-day mortality, survival, and QOL before and 1 and 3 months after stenting were compared between the 2 groups. All patients were followed up until death. RESULTS: Fifty-four patients were randomized to PTBD or ES (27 each). Successful drainage was better in the PTBD group (89% vs 41%; P < .001). Early cholangitis was significantly higher in the ES group (48% vs 11%; P = .002). Procedure-related (4% vs 8%) and 30-day mortality (4% vs 8%) and median survival were similar (60 days in both; P = .71). Although the World Health Organization-Quality of Life 1- and 3-month physical and psychological scores were better after PTBD, the difference was not significant. The European Organization for Research and Treatment of Cancer (EORTC)-Quality of Life Questionnaire 30 global health status at 3 months was significantly better after PTBD (75 vs 30.5, P = .02). The EORTC symptom scores improved in both groups, but only fatigue was significantly better after PTBD. CONCLUSIONS: PTBD provides better biliary drainage and has lower complication rates in patients with GBC and hilar block. SN - 1542-7714 UR - https://www.unboundmedicine.com/medline/citation/18585976/Endoscopic_or_percutaneous_biliary_drainage_for_gallbladder_cancer:_a_randomized_trial_and_quality_of_life_assessment_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(08)00341-8 DB - PRIME DP - Unbound Medicine ER -