Factors predicting 30-day mortality after ERCP in patients with inoperable malignant hilar biliary obstruction: a single tertiary referral centre experience and systematic review
Objective There is a paucity of studies in the literature body evaluating short term outcomes following endoscopic retrograde cholangiopancreatography (ERCP) in patients with inoperable malignant hilar biliary obstruction (MHBO). We aimed to primarily evaluate 30-day mortality in these patients and...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-07-01
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| Series: | BMJ Open Gastroenterology |
| Online Access: | https://bmjopengastro.bmj.com/content/9/1/e000878.full |
| _version_ | 1797780262944243712 |
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| author | Simon M Everett Bharat Paranandi Matthew T Huggett Vinod S Hegade Wei On Muhammad A Saleem |
| author_facet | Simon M Everett Bharat Paranandi Matthew T Huggett Vinod S Hegade Wei On Muhammad A Saleem |
| author_sort | Simon M Everett |
| collection | DOAJ |
| description | Objective There is a paucity of studies in the literature body evaluating short term outcomes following endoscopic retrograde cholangiopancreatography (ERCP) in patients with inoperable malignant hilar biliary obstruction (MHBO). We aimed to primarily evaluate 30-day mortality in these patients and secondarily, conduct a systematic review of studies reporting 30-day mortality.Design We conducted a retrospective analysis of all patients with inoperable MHBO who underwent ERCP at Leeds Teaching Hospitals NHS Trust between February 2015 and September 2020. Logistic regression models constructed from baseline patient data, the modified Glasgow Prognostic Score (mGPS) and Charlson Comorbidity Index (CCI) were evaluated as predictors of 30-day mortality.Results Eighty-seven patients (49 males) with a mean age of 70.4 years (SD ±12.3) were included. Cholangiocarcinoma was the most common aetiology of MHBO affecting 35/87 (40.2%). Technical success was achieved in 72/87 (82.8%). The 30-day mortality rate was 25.3% (22/87), of which 16 were due to progression of underlying malignant disease. On multivariate analysis, only leucocytosis (OR 4.12, 95% CI 2.70 to 7.41, p=0.02) was an independent predictor of 30-day mortality. Neither mGPS (p=0.47) nor CCI with a cut-off value of ≥7 (p=0.06) were significant predictors of 30-day mortality.Conclusion We demonstrated that 30-day mortality following ERCP for inoperable MHBO remains high despite technical success. Further studies are warranted to identify patients most appropriate for intervention. |
| first_indexed | 2024-03-12T23:41:55Z |
| format | Article |
| id | doaj.art-cc7d39433024439281c0338083e39ed4 |
| institution | Directory Open Access Journal |
| issn | 2054-4774 |
| language | English |
| last_indexed | 2024-03-12T23:41:55Z |
| publishDate | 2022-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Gastroenterology |
| spelling | doaj.art-cc7d39433024439281c0338083e39ed42023-07-14T15:00:07ZengBMJ Publishing GroupBMJ Open Gastroenterology2054-47742022-07-019110.1136/bmjgast-2022-000878Factors predicting 30-day mortality after ERCP in patients with inoperable malignant hilar biliary obstruction: a single tertiary referral centre experience and systematic reviewSimon M Everett0Bharat Paranandi1Matthew T Huggett2Vinod S Hegade3Wei On4Muhammad A Saleem5Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UKDepartment of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UKDepartment of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UKLeeds Liver Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UKDepartment of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UKDepartment of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UKObjective There is a paucity of studies in the literature body evaluating short term outcomes following endoscopic retrograde cholangiopancreatography (ERCP) in patients with inoperable malignant hilar biliary obstruction (MHBO). We aimed to primarily evaluate 30-day mortality in these patients and secondarily, conduct a systematic review of studies reporting 30-day mortality.Design We conducted a retrospective analysis of all patients with inoperable MHBO who underwent ERCP at Leeds Teaching Hospitals NHS Trust between February 2015 and September 2020. Logistic regression models constructed from baseline patient data, the modified Glasgow Prognostic Score (mGPS) and Charlson Comorbidity Index (CCI) were evaluated as predictors of 30-day mortality.Results Eighty-seven patients (49 males) with a mean age of 70.4 years (SD ±12.3) were included. Cholangiocarcinoma was the most common aetiology of MHBO affecting 35/87 (40.2%). Technical success was achieved in 72/87 (82.8%). The 30-day mortality rate was 25.3% (22/87), of which 16 were due to progression of underlying malignant disease. On multivariate analysis, only leucocytosis (OR 4.12, 95% CI 2.70 to 7.41, p=0.02) was an independent predictor of 30-day mortality. Neither mGPS (p=0.47) nor CCI with a cut-off value of ≥7 (p=0.06) were significant predictors of 30-day mortality.Conclusion We demonstrated that 30-day mortality following ERCP for inoperable MHBO remains high despite technical success. Further studies are warranted to identify patients most appropriate for intervention.https://bmjopengastro.bmj.com/content/9/1/e000878.full |
| spellingShingle | Simon M Everett Bharat Paranandi Matthew T Huggett Vinod S Hegade Wei On Muhammad A Saleem Factors predicting 30-day mortality after ERCP in patients with inoperable malignant hilar biliary obstruction: a single tertiary referral centre experience and systematic review BMJ Open Gastroenterology |
| title | Factors predicting 30-day mortality after ERCP in patients with inoperable malignant hilar biliary obstruction: a single tertiary referral centre experience and systematic review |
| title_full | Factors predicting 30-day mortality after ERCP in patients with inoperable malignant hilar biliary obstruction: a single tertiary referral centre experience and systematic review |
| title_fullStr | Factors predicting 30-day mortality after ERCP in patients with inoperable malignant hilar biliary obstruction: a single tertiary referral centre experience and systematic review |
| title_full_unstemmed | Factors predicting 30-day mortality after ERCP in patients with inoperable malignant hilar biliary obstruction: a single tertiary referral centre experience and systematic review |
| title_short | Factors predicting 30-day mortality after ERCP in patients with inoperable malignant hilar biliary obstruction: a single tertiary referral centre experience and systematic review |
| title_sort | factors predicting 30 day mortality after ercp in patients with inoperable malignant hilar biliary obstruction a single tertiary referral centre experience and systematic review |
| url | https://bmjopengastro.bmj.com/content/9/1/e000878.full |
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