The researchers compared the outcome of unilateral versus bilateral drainage in patients with biliary obstruction at the hilum.
They reported their findings in the May issue of Gastrointestinal Endoscopy.
157 consecutive patients with primary cholangiocarcinoma, gallbladder cancer, or periportal lymph node metastases were randomly allocated to unilateral (Group A) or bilateral (Group B) hepatic duct drainage.
In intention-to treat analysis, Group A had a significantly higher rate of successful endoscopic stent insertion than Group B (89% vs. 77%).
Hepatic duct drainage complication rates:|
Group B was found to have a significantly higher rate of complications than Group A (27% vs. 19%). This was due to the higher rate of early cholangitis in Group B (17% vs. 9%).
In per-protocol analysis the rate of successful drainage, complications, and mortality did not differ between the two groups.
Median survival was the same for both groups, but was significantly different for patients with cholangiocarcinoma and those with gallbladder cancer versus patients with metastatic tumors.
Dr Giovanni D. De Palma, of the University of Naples Federico II, concluded on behalf of the group, "The insertion of more than one stent would not appear justified as a routine procedure in patients with biliary bifurcation tumors."