ERCP and stent therapy for progressive jaundice in hepatocellular carcinoma: Which patients benefit, which patients don't?

John A. Martin, Adam Slivka, Mordechai Rabinovitz, Brian I. Carr, John Wilson, William B. Silverman

Research output: Contribution to journalArticlepeer-review

Abstract

Jaundice in hepatocellular carcinoma (HCC) can be due to biliary obstruction. Endoscopic retrograde cholangiopancreatography (ERCP) can be both diagnostic and therapeutic. Biliary stenting can relieve jaundice and allow further chemotherapy, but at additional expense and potential morbidity. We sought to determine whether CT scan or ultrasound (US) could identify which patients with HCC and jaundice would benefit from endoscopic stenting. We retrospectively analyzed 26 patients with HCC and jaundice who underwent ERCP after CT or US. We compared biliary dilation on CT or US with the dominant biliary stricture seen on ERCP, and with response to biliary stenting. Eleven of 26 patients had dominant biliary stricture on ERCP; 11 underwent stenting. Six of 11 (55%) stented patients had a significant decline in bilirubin; three became eligible for further chemotherapy. All six responders to stenting had biliary dilation on prior CT or US. Procedure- related complications occurred in 1/11 (9%) who underwent stent placement. In conclusion, in selected patients, stenting can safely relieve jaundice and allow subsequent chemotherapy. CT or US accurately predicted lesions that responded to stenting. ERCP and stenting provided no benefit in the absence of biliary dilation on CT or US.

Original languageEnglish
Pages (from-to)1298-1302
Number of pages5
JournalDigestive Diseases and Sciences
Volume44
Issue number7
DOIs
Publication statusPublished - 1999

Keywords

  • Biliary stricture
  • Endoscopic retrograde cholangiopancreatography
  • Hepatocellular carcinoma
  • Stent

ASJC Scopus subject areas

  • Gastroenterology

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