Introduction Malignant biliary obstruction has a poor prognosis unless secondary to a resectable primary cancer. Recent data on PTC for the relief of malignant obstruction in a palliative setting demonstrated a high early mortality. We have therefore examined outcomes of ERCP in inoperable malignant obstruction.
Method The Hospital Episode Statistics (HES) database contains diagnostic and procedural data for all hospital attendances in England. HES is linked to the Office for National Statistics (ONS) to provide mortality data. All subjects from April 2001 to April 2015 in England with an ICD10 code for cancer 2 years prior to ERCP or in the following 6 months were examined. Subjects undergoing a curative surgical procedure were excluded. Associations between demographics, co-morbidities, unit ERCP volume and mortality were examined by logistic regression.
Results 49055 subjects were included in the study of whom 48.7% were male, median age 74.5 years (range 19–104). Pancreatic cancer was the most common aetiology (63.5%) followed by liver and intrahepatic bile duct malignancy (19.4%). Mortality was 4.16%, 10.9% and 19.6% for 7 day, in hospital and 30 day respectively. In multivariate analysis male gender (OR 1.14, (95% CI 1.08–1.20) p<0.001); increasing by age quintile 64–71 (1.34, (1.23–1.47) p<0.001), 72–77 (1.57, (1.44–1.72) p<0.001), 78–83 (1.83, (1.68–2.00) p<0.001),>83 (2.78, (2.55–3.03), p<0.001); most deprived quintile (1.22, (1.12–1.33), p<0.001); increasing co-morbidity score 1 to 5 (1.09, (1.02–1.16), p=0.012), 6 to 10 (1.23, (1.12–1.35), p<0.001) 11 to 15 (1.49, (1.33–1.66), p<0.001), 16 to 20 (1.97, (1.70–2.28), p<0.001),>20 (2.79 (2.39–3.25), p<0.001); advancing year of ERCP 2013/14 (0.78, (0.68–0.90), p=0.001), 2014/15 (0.85, (0.74–0.98) p=0.028); and previous renal failure (1.92, (1.77–2.09), p<0.001) were associated with increasing 30 day mortality. Asian ethnicity (0.82, (0.67–0.99), p=0.036), Cancer of extrahepatic and unspecified parts of biliary tree (0.60, (0.55–0.65), p<0.001) and upper tertile of unit ERCP activity (>230) per annum (0.86, (0.80–0.93), p<0.001) were negatively associated with 30 day mortality.
Conclusion Short term mortality in subjects with malignant biliary obstruction following ERCP was high. A better prognosis was observed in; high volume ERCP units, Asian ethnicity and extrahepatic primary cancers. Male gender, advancing age, increasing co-morbidity score, greater deprivation and previous renal failure predicted death at 30 days.
Disclosure of Interest None Declared
- biliary obstruction
- ERCP (Endoscopic retrograde cholangiopancreatography)
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