Introduction

Endoscopic drainage is the standard of care in patients with malignant biliary obstruction (MBO).

Aim

The aim of this study was to investigate the efficacy of biliary stenting in providing access to systemic chemotherapy.

Material and methods

Patients with bile duct obstruction (bilirubin > 2.5 mg/dl) caused by unresectable biliary or pancreatic cancer were retrospectively analysed with respect to use of chemotherapy and survival. Laboratory data were analysed at baseline, 7–10, and 28–35 days following biliary stenting.

Results

Patients with MBO (n = 78) were allocated into one of three groups according to baseline bilirubin level [mg/dl]: 2.5–5.99 (1), 6.0–15.0 (2), and > 15 (3). At the first test, the mean bilirubin decrease from baseline in the respective groups was as follows: 1.19 (29.5%), 3.77 (38.5%), 7.1 (27.3%), and at the second measurement: 1.61 (40%), 5.69 (58.2%), 13.0 (50%), respectively. Chemotherapy was applied in 28 (35.8%) patients, less frequently in group 3 than in 1 (31.2% vs. 44.0%; p = 0.07) and 2 (vs. 38.1%; p = 0.06). The mean survival time was 4.8 ±2.8 months and was significantly shorter in group 3 than in group 2 (3.8 ±2.0 vs. 6.2 ±3.9 months; p = 0.02) and 1 (vs. 5.4 ±2.7 months; p = 0.03).

Conclusions

In two-thirds of patients with MBO, endoscopic biliary drainage does not secure access to chemotherapy. The use of chemotherapy and survival time are significantly higher in patients with a bilirubin level below 15 mg/dl as compared to those with higher bilirubinaemia, but biliary drainage is only minimally effective in patients with a bilirubin level below 6 mg/dl.