Biliary drainage for obstructive jaundice caused by unresectable hepatocellular carcinoma: the
endoscopic versus percutaneous approach
Jongkyoung Choi, Ji Kon Ryu, Sang Hyub Lee, Dong-Won Ahn, Jin-Hyeok Hwang,
Yong-Tae Kim, Yong Bum Yoon and Joon Koo Han
Seoul, Korea

BACKGROUND: For palliative treatment of the obstructive
jaundice associated with unresectable hepatocellular carcinoma
(HCC), percutaneous transhepatic biliary drainage (PTBD)
or endoscopic retrograde biliary drainage (ERBD) has been
performed. PTBD is preferred as an initial procedure. Little is
known about the better option for patients with obstructive
jaundice caused by unresectable HCC.
METHODS: Sixty patients who had received ERBD or PTBD
for the palliative treatment of obstructive jaundice caused by
unresectable HCC between January 2006 and May 2010 were
included in this retrospective study. Successful drainage, drainage
patency, and the overall survival of patients were evaluated.
RESULTS: Univariate analysis revealed that the overall
frequency of successful drainage was higher in the ERBD
group (22/29, 75.9%) than in the PTBD group (15/31, 48.4%)
(P=0.029); but multivariate analysis showed marginal
significance (P=0.057). The duration of drainage patency was
longer in the ERBD group than in the PTBD group (82 vs 37
days, respectively, P=0.020). Regardless of what procedure
was performed, the median survival time of patients who
had a successful drainage was much longer than that of the
patients who did not have a successful drainage (143 vs 38 days,
respectively, P<0.001).

CONCLUSION: Besides PTBD, ERBD may be used as the initial
treatment option to improve obstructive jaundice in patients
with unresectable HCC if there is a longer duration of drainage
patency after a successful drainage.
(Hepatobiliary Pancreat Dis Int 2012;11:636-642)