ERCP for the initial management of malignant biliary obstruction – real world data on 596 procedures

To evaluate outcomes of ERCP as first-line management in patients with malignant biliary obstruction (MBO) of all causes and stages, reflecting a real-life setting.
Retrospective observational study of patients with ERCP as the first-line management of MBO at Oslo University Hospital between 2015 and 2021. Primary outcome measure was a ≥ 50% decrease from the pre-procedural bilirubin within 30 days after ERCP. Secondary outcome measures were technical success of ERCP, complications and overall mortality.
A total of 596 patients were included, median age 70 years. ASA score was ≥ III in 67% of patients. The most common cancers causing MBO were pancreatic cancer (52%), metastatic lesions (20%) and cholangiocarcinoma (16%). The primary outcome measure was achieved in 62% of patients. With endoscopic access, overall technical success was 80% with 85% for the distal extrahepatic group, 71% for the perihilar, 40% for the intrahepatic and 53% for multiple level MBOs. Reinterventions were performed in 27% of the patients. Complications occurred in 15% of the patients, including post-ERCP pancreatitis in 9%. Most complications were of minor/moderate severity (81%). Overall mortality was 33% within the first 90 days. Patients deceased by the end of the study period (83%) had median survival of 146 days (range 1–2,582 days).
ERCP has a high rate of clinical effect and technical success in the management of both distal extrahepatic and perihilar MBO. Our data indicate that ERCP is a valid option in the first-line management of MBO.

本研究旨在评估内镜逆行胰胆管造影术（Endoscopic Retrograde Cholangiopancreatography，ERCP）作为各类病因与分期恶性胆道梗阻（Malignant Biliary Obstruction，MBO）患者一线治疗方案的临床结局，以反映真实临床实践场景。
本研究为回顾性观察研究，纳入2015年至2021年间在奥斯陆大学医院接受ERCP作为MBO一线治疗的患者。主要结局指标为ERCP术后30天内患者血清胆红素水平较术前降低≥50%；次要结局指标包括ERCP操作技术成功率、并发症发生率及总死亡率。
本研究共纳入596例患者，中位年龄为70岁。其中67%的患者美国麻醉医师协会（American Society of Anesthesiologists，ASA）评分≥Ⅲ级。导致MBO的常见恶性肿瘤依次为胰腺癌（52%）、转移性病灶（20%）及胆管癌（16%）。62%的患者达成主要结局指标。经内镜入路下，整体技术成功率为80%：其中远端肝外梗阻组为85%，肝门部梗阻组为71%，肝内梗阻组为40%，多部位梗阻组为53%。27%的患者接受了再次干预治疗。15%的患者出现并发症，其中9%为ERCP术后胰腺炎；多数并发症为轻中度（占比81%）。术后90天内总死亡率为33%。至研究周期结束时死亡的患者（占比83%）中位生存期为146天（范围1~2582天）。
ERCP在远端肝外及肝门部MBO的治疗中，临床有效率与技术成功率均较高。本研究数据表明，ERCP可作为MBO一线治疗的合理选择。