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Corresponding Author

Hassan Atalla

Subject Area

Hepatology and GIT

Article Type

Original Study

Abstract

Background: Malignant extrahepatic biliary obstruction (MEBO) is a common cause of obstructive jaundice associated with high morbidity and mortality. ERCP-guided biliary drainage is widely used for palliative management, however, real-world data regarding bilirubin decline and predictors of success remain limited. This study aimed to evaluate bilirubin decline patterns, clinical outcomes, and predictors of clinical success following ERCP-guided biliary drainage in patients with MEBO.

Methods: This prospective observational study included consecutive MEBO patients who underwent ERCP-guided biliary drainage either by plastic or metallic stents at a tertiary-care hospital. Technical success, defined as successful stent placement, and clinical success, defined as symptomatic improvement and >30% reduction in serum bilirubin at 1 week, were predefined as outcome targets.

Results: Seventy-seven patients were included. Technical success was achieved in 96.1%. Among technically successful procedures, clinical success at 1 week was achieved in 60.8% of patients.  The median hospital stay was 5.5 days.ICU admission occurred in 6.5%; and reintervention was required in 13.0%. Chemotherapy was administered to 35.1% of patients. Early mortality within 1 week occurred in 6.5% while overall mortality during follow-up was 51.9%.

Conclusion: ERCP-guided biliary drainage is an effective and safe palliative treatment for MEBO. Early bilirubin reduction predicts clinical benefit and may facilitate subsequent chemotherapy in selected patients, although overall mortality remains high due to advanced underlying malignancy. Further larger studies are warranted to validate these findings.

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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