Efficacy of 3-D reconstruction assisted ERCP biliary drainage for resectable hilar cholangiocarcinoma

Abstract

Abstract Background and aims: ERCP-guided biliary drainage (ERCP-BD) is a standard treatment for malignant biliary obstruction. For the drainage of hilar cholangiocarcinoma (HCCA), ERCP-BD has always been controversial due to the high incidence of postoperative cholangitis. In this study, we used a 3-D reconstruction technology (IQQA®-liver) to provide an accurate spatial conformation between tumors and bile ducts, and significantly reduced the incidence of cholangitis. Methods A total of 12 patients with HCCA were included in this study during 2017–2018. All patients underwent thin-layer CT scan and MRCP before ERCP-BD to identify the obstruction site and tumor location. The 3-D imaging system was used to accurately locate the tumors and bile ducts. Based on it, we selected the appropriate drainage of hepatic lobes. Intraoperative air cholangiography and nasobiliary drainage were performed, and nasojejunal tubes were placed for external biliary recycle. Results All patients underwent successful ERCP procedure and were placed with nasobiliary drainage. One patient also underwent plastic biliary stent implantation. Intraoperative, 4 patients were placed with pancreatic duct stents and 3 patients underwent small endoscopic sphincterotomy (EST). After ERCP, 1 patient presented with mild pancreatitis and cholangitis. No patients received additional percutaneous transhepatic biliary drainage (PTBD) due to insufficient drainage. Except two patients, the remaining patients received radical surgical treatment. Conclusion The 3-D reconstruction assisted precision ERCP-BD is a safe and effective method, it can reduce the risk of post-ERCP cholangitis in HCCA patients. Precision ERCP-BD might be justified as a routine procedure for HCCA patients with hyperbilirubinemia.