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CC BY 4.0 · Endosc Int Open 2026; 14: a27606318
DOI: 10.1055/a-2760-6318
Original article

Which patients with palliative malignant biliary obstruction will benefit most from biliary drainage: Development and validation of a prognostic score

Authors

  • Raphael Olivier

    1   Hepato-Gastroenterology, CHU Poitiers, Poitiers, France (Ringgold ID: RIN36655)

  • Estelle Antoine

    1   Hepato-Gastroenterology, CHU Poitiers, Poitiers, France (Ringgold ID: RIN36655)

  • Marie Morvan

    2   Hepato-Gastroenterology, CHRU de Brest, Brest, France (Ringgold ID: RIN26990)

  • Augustin D'Aubigny

    3   Hepato-Gastroenterologie, Centre Hospitalier de Cornouaille, Quimper, France (Ringgold ID: RIN55151)

  • Jean Baptiste Nousbaum

    2   Hepato-Gastroenterology, CHRU de Brest, Brest, France (Ringgold ID: RIN26990)

  • Noemie Reboux

    2   Hepato-Gastroenterology, CHRU de Brest, Brest, France (Ringgold ID: RIN26990)

  • Enrique Perez Cuadrado Robles

    4   Hôpital Européen Georges Pompidou, Paris, France (Ringgold ID: RIN55647)

  • Lucille Queneherve

    2   Hepato-Gastroenterology, CHRU de Brest, Brest, France (Ringgold ID: RIN26990)
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Abstract

Background and study aims

Biliary drainage is performed in palliative malignant biliary obstruction (MBO) to improve patient quality of life and enable chemotherapy. This study aimed to create and validate a prognostic score after biliary drainage in patients with palliative MBO.

Patients and methods

Patients undergoing endoscopic or percutaneous drainage for palliative MBO were included in a multicenter, retrospective study. Probability factors associated with 30-day mortality were evaluated by univariable and multivariable logistic regression in the derivation cohort and a prognostic score was built and evaluated in an independent validation cohort.

Results

The derivation cohort included 262 patients, 55% male, 61% of whom had pancreatic adenocarcinoma, mean age 72 years. Probability factors associated with 30-day mortality identified in the derivation cohort were World Health Organization performance status of 3–4 (odds ratio [OR] 7.7 [2.57–25.0] ; +3 points), liver metastases (OR 2.7 [1.06–6.98] ; +1 point), other metastases (OR 3.85 [1.57–9.97] ; +2 points), leukocytes >12G/l (OR 2.4 [0.94–6.08]; +1 point), total bilirubin > 10.8 mg/dL (OR 4.3 [1.45–15.20] ; +2 points) and creatininemia > 5.0 mg/dL (OR 7.3 [2.89–19.86]; +3 points). The multivariable model showed good discrimination, with an area under the receiver operating curve (AUROC) of 0.86 (95% confidence interval 0.80–0.93). The prognostic score was used to define two groups of patients, with a low (0–4 points) or high-probability (> 4 points) of 30-day mortality (3% and 32%, respectively). The AUROC in the validation cohort (192 patients) was 0.72, with 30-day mortality of 7% in the low- probability group and 22% in the high- probability group (P = 0.02).

Conclusions

This score could be used in routine clinical practice to identify patients who have better survival outcomes after biliary drainage in palliative MBO.

Keywords

Pancreatobiliary (ERCP/PTCD) - ERC topics - MRCP topics - PTCD/PTCS

Supplementary Material



Publication History

Received: 30 March 2025

Accepted after revision: 08 October 2025

Accepted Manuscript online:
01 December 2025

Article published online:
21 January 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Raphael Olivier, Estelle Antoine, Marie Morvan, Augustin D'Aubigny, Jean Baptiste Nousbaum, Noemie Reboux, Enrique Perez Cuadrado Robles, Lucille Queneherve. Which patients with palliative malignant biliary obstruction will benefit most from biliary drainage: Development and validation of a prognostic score. Endosc Int Open 2026; 14: a27606318.
DOI: 10.1055/a-2760-6318
 

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