Preoperative biliary drainage associated with biliary stricture after pancreaticoduodenectomy: a population‐based study

• Published in: Journal of hepato-biliary-pancreatic sciences 2018-06, Vol.25 (6), p.308-318
• Main Authors: Wu, Chien‐Hui, Ho, Te‐Wei, Wu, Jin‐Ming, Kuo, Ting‐Chun, Yang, Ching‐Yao, Lai, Fei‐Pei, Tien, Yu‐Wen
• Format: Article
• Language: English
• Subjects: Cholangiopancreatography; Endoscopic retrograde; Interventional radiography; Pancreaticoduodenectomy; Population-based studies; Postoperative complications
• ISSN: 1868-6974; 1868-6982
• DOI: 10.1002/jhbp.559

Background The rate of preoperative biliary drainage for pancreaticoduodenectomy has been increasing despite most recent evidence that favors avoiding it. Only a few studies have focused on late surgical complications – biliary stricture after pancreaticoduodenectomy and have produced only inconclusive results. We evaluate the role of preoperative biliary drainage in the formation of biliary stricture after pancreaticoduodenectomy. Methods The Taiwan National Health Insurance Program is a mandatory health care plan that covers nearly the entire population of 23 million in this country. A retrospective study was conducted to analyze the database compiled by the Taiwan National Health Insurance between January 2000 and December 2011. We included only patients with at least 2 years of follow‐up. A cohort of 2,087 patients with preoperative diagnosis of biliary obstruction that underwent pancreaticoduodenectomy was evaluated. Results A total of 212 (10.1%) of the 2,087 studied patients needed intervention for biliary stricture after pancreaticoduodenectomy. The median time to biliary stricture formation was 15.2 months (range: 1.2–89.7 months). The cumulative biliary stricture rate was 6.9% (1 year), 15.8% (5 years), and 18.5% (10 year). Multivariate analysis showed preoperative biliary drainage (hazard ratio 1.78, 95% CI 1.27–2.50, P = 0.001) associated with biliary stricture after pancreaticoduodenectomy. Conclusions Preoperative biliary drainage increases biliary stricture rate after pancreaticoduodenectomy. Highlight Wu and colleagues found that 18.5% of patients who underwent pancreaticoduodenectomy developed biliary stricture within 10 years after surgery. Both percutaneous transhepatic biliary drainage and endoscopic stenting were found to be significant predictors. Preoperative biliary drainage is not recommended because it increases the risk of biliary stricture after pancreaticoduodenectomy.