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Bismuth classification is associated with the requirement for multiple biliary drainage in preoperative patients with malignant perihilar biliary stricture

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Abstract

Background

Single preoperative biliary drainage for malignant perihilar biliary stricture occasionally fails to control jaundice and cholangitis. Multiple biliary drainage is required in such cases, but their clinical background is unclear. We determined the clinical characteristics associated with the requirement for multiple biliary drainage.

Methods

The consecutive 122 patients with malignant perihilar biliary stricture were enrolled in a single-center retrospective study. Preoperative biliary drainage was initially performed on the future remnant hepatic lobe. Additional drainage was performed if jaundice failed to improve or cholangitis developed in undrained hepatic lobes. Detailed clinical characteristics and the number of preoperative biliary drainage procedures required before operation were analyzed.

Results

Thirty-one patients (25.4 %) initially underwent multiple biliary drainage. However, 69 (56.7 %) required multiple biliary drainage by the time of the operation. In the univariate analysis, the initial serum bilirubin level, cholangitis, percutaneous portal vein embolization, history of inserted endoscopic biliary stenting, length of preoperative period, operative procedure, and Bismuth classification were significant factors. In the multivariate analysis using these factors, Bismuth classification was independently associated with the requirement for multiple biliary drainage. The number of patients who required multiple biliary drainage was higher in those with Bismuth-II (91.9 %), Bismuth-IIIa (65.7 %), and Bismuth-IV (92.9 %) than in those with Bismuth-I (22.2 %) and Bismuth-IIIb (18.2 %).

Conclusions

Patients with Bismuth-II, Bismuth-IIIa, and Bismuth-IV are at higher risk for multiple biliary drainage. A strategy based on the Bismuth classification for performing preoperative biliary drainage is important for patients with malignant perihilar biliary stricture.

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Abbreviations

BD:

Biliary drainage

B-classification:

Bismuth-classification

EBS:

Endoscopic biliary stenting

ENBD:

Endoscopic naso-biliary drainage

ERCP:

Endoscopic retrograde cholangiopancreatography

MBD:

Multiple biliary drainage

NACRT:

Neo-adjuvant chemo-radiation therapy

PTBD:

Percutaneous transhepatic biliary drainage

PTPE:

Percutaneous portal vein embolization

SBD:

Single biliary drainage

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Disclosures

Shin Miura, Atsushi Kanno, Atsushi Masamune, Shin Hamada, Tetsuya Takikawa, Eriko Nakano, Naoki Yoshida, Seiji Hongo, Kazuhiro Kikuta, Kiyoshi Kume, Morihisa Hirota, Hiroshi Yoshida, Yu Katayose, Michiaki Uuno, and Tooru Shimosegawa have no conflict of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai, Miyagi, Japan

    Shin Miura, Atsushi Kanno, Atsushi Masamune, Shin Hamada, Tetsuya Takikawa, Eriko Nakano, Naoki Yoshida, Seiji Hongo, Kazuhiro Kikuta, Kiyoshi Kume, Morihisa Hirota & Tooru Shimosegawa

  2. Department of Hepato-Biliary Pancreatic Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan

    Hiroshi Yoshida, Yu Katayose & Michiaki Uuno

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  1. Shin Miura
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  2. Atsushi Kanno
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  15. Tooru Shimosegawa
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Correspondence to Atsushi Kanno.

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Miura, S., Kanno, A., Masamune, A. et al. Bismuth classification is associated with the requirement for multiple biliary drainage in preoperative patients with malignant perihilar biliary stricture. Surg Endosc 29, 1862–1870 (2015). https://doi.org/10.1007/s00464-014-3878-y

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  • DOI: https://doi.org/10.1007/s00464-014-3878-y

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