THE ROLE OF A DIFFERENTIATED APPROACH IN IMPROVING THE EFFECTIVENESS OF MINIMALLY INVASIVE DRAINAGE IN TUMOR-INDUCED BILIARY OBSTRUCTION
Keywords:
obstructive jaundice; hepatopancreatobiliary tumors; endoscopic stenting; percutaneous drainage; plastic stents; self-expanding metal stentsAbstract
Obstructive jaundice caused by malignant tumors is a severe complication of hepatopancreatobiliary cancers. Its occurrence in advanced cases is frequent, and many patients eventually develop jaundice. Given that only 20–25% of these tumors are resectable, palliative biliary decompression methods are crucial. However, there is no single standard approach to malignant jaundice, and various minimally invasive techniques – endoscopic or percutaneous drainage, plastic or metal stenting, etc. – are employed based on institutional experience. This article presents a study of 149 patients with malignant obstructive jaundice who underwent 133 minimally invasive biliary drainages (either retrograde endoscopic or antegrade percutaneous) and 16 palliative surgical biliodigestive bypass operations. The outcomes were analyzed to develop a differentiated strategy for choosing the optimal drainage method depending on the tumor block level, anatomical considerations, expected patient survival, and performance status. The results demonstrate that minimally invasive biliary decompression effectively relieves jaundice in the majority of patients and is associated with fewer complications compared to open surgical bypass. Algorithms were developed suggesting that if expected survival is less than 6 months, biliary drainage with a plastic stent (via ERCP or PTC) is preferable, whereas for survival over 6 months, a self-expanding metal stent (SEMS) or surgical bypass should be considered. These findings indicate that a tailored approach can improve outcomes of malignant obstructive jaundice by reducing complication and mortality rates.
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