Z Gastroenterol 2016; 54 - P24
DOI: 10.1055/s-0036-1584002

Therapeutic options in patients with malignant biliary obstruction – a retrospective single center analyze

R Schwarzer 1, S Hametner 1, A Ziachehabi 1, S Gerstl 1, R Függer 2, R Schöfl 1, A Maieron 1
  • 1Elisabethinen Krankenhaus Linz – Gastroenterologie und Hepatologie, Linz, Austria
  • 2Elisabethinen Krankenhaus Linz – Chirurgie, Linz, Austria

Aim: Malignant biliary obstruction (MBO) is mostly caused by cholangiocarcinoma. Aim of this analysis was to assess the therapeutic algorithm of cholangiocarcinoma the survival time throw-out the different therapeutic approaches in our hospital (KHE).

Methods: 20 patients (50% male, median age 75 years (range 52; 85) were referred to the KHE for MBO between August 2011 and February 2016.

All patients underwent ERCP and were classified according Bismuth classification A multidisciplinary team judged whether patient was suitable for radical treatment.

Results: 19 patients were classified according Bismuth. (Type 1: 3 pts;; Type 3a: 1; Type 3b: 2; Type 4a: 12; Type 4b: 1).

1 patient had Gallbladder cancer with spread into the bile duct. During ERC biopsy, bile brush and cholangiogram was performed.

Histological- or cytological assessment was performed in 14 out of 20 patients during ERCP and revealed a positive finding in 8 out of 14 (57%) patients (4 epithelial dysplasia, 4 patients with adenocarcinoma).

Endoscopic approach was chosen in 11 out of 20 patients.

Surgery was performed in 9 patients. 5 patients underwent primary hemihepatectomy (4 left hemihepatectomy; 1 whipple surgery). 4 patients had liver augmentation with portal vein embolization prior to surgical intervention (2 right hemihepatectomy; 2 extended right hemihepatectomy).

Despite liver augmentation, 2 patients experienced post-operative liver failure.

Mean survival was 18 months. The mean survival was 19 months after surgery (23months without postoperative liver failure (n = 2)). In contrast the mean survival is 17 months in patients with non-surgical management (Stent 36 months (n = 2); RFA/Stent 13 months (n = 9)).

Conclusio: Managing MBO remains challenging. Multidisciplinary, including radiologist, surgeons and gastroenterologist approach yields highly rates of resection, which remains the only curative treatment.

Tumor resection is the only potential curative therapy. However, we observed in one patient a survival of 46 months after endoscopic approach.