Endoscopic treatment of biliary tract cancer (Article) [Trattamento endoscopico delle neoplasie della via biliare]

Bile duct cancer has a low surgical resectability rate and a poor survival rate even in the short term. Bile duct cysts, ulcerative colitis, sclerosing cholangitis, hepatolithiasis, some parasitoses such as liver fluke infestations, and thorotrast exposure are associated with an increased risk of bile duct cancer. The aim of this retrospective study is to evaluate the results of palliative endoscopic treatment in non-operable patients and the usefulness of preoperative endoscopic biliary drainage. From November 1987 to October 2004, 1313 patients with obstructive jaundice were submitted to endoscopic retrograde cholangiopancreatography (ERCP). In 247 patients (21.8%) this jaundice was due to a bile duct cancer. There were 139 males and 108 females with an average overall age of 66.1 years. Endoscopic internal biliary drainage was successful in 224 patients (90.7%). Palliative endoscopic biliary drainage was the definitive treatment in 166 patients (67.2%). There were 21 early complications (8.5%), including 17 cholangitis, 2 bleedings, one pancreatitis and one retroduodenal perforation. Late occlusion of stent caused cholangitis in 49 patients. There were no deaths related to endoscopic drainage. Average patency was 101 days for plastic stents and 152 days for metallic stents. Radical surgery is the only curative option for bile duct cancer, but the high percentage of patients (in particular in the case of tumours of the intrahepatic bile duct) who, at diagnosis, have a non-resectable disease, puts the problem of which palliative therapy should be chosen. In these patients, endoscopic drainage seems to be successful in an adequate percentage of cases.