Transjugular insertion of biliary stent in patients with malignant biliary obstruction complicated by ascites with/without coagulopathy: a prospective study of 12 patients.

PURPOSE In patients with malignant biliary obstruction and complicated by massive ascites, when endoscopy failed, safe routes for biliary decompression are needed alternative to percutaneous approach. We evaluated the safety and efficacy of transjugular insertion of biliary stent (TIBS) in patients with malignant biliary obstruction complicated by massive ascites with or without coagulopathy. METHODS From March 2012 to December 2017, a total of 12 consecutive patients with malignant biliary obstructions treated with TIBS was enrolled in this study. Five patients had jaundice with cholangitis and seven had only jaundice. Clinical parameters including technical and clinical success rate and complications following TIBS were evaluated. Overall survival and stent occlusion-free survival were assessed using Kaplan-Meier analysis. RESULTS The indications for transjugular approach were massive ascites with (n=2) or without (n=10) coagulopathy. TIBS was technically successful in 11 of 12 patients. Clinical success was defined as successful internal drainage and achieved in eight patients. The mean serum bilirubin level was initially 13.9±6.3 mg/dL and decreased to 4.9±5.3 mg/dL within 1 month after stent placement (P = 0.037). Two patients had procedure-related complications (hemobilia). During the follow-up period (mean=30 days, range=1-146 days), all 12 patients died of disease progression. The median overall survival and stent occlusion-free survival times were 19 days (95% confidence interval=16-22 days) and 19 days (95% confidence interval=12-26 days), respectively. There was no stent dysfunction in the eight patients that had successful internal drainage. CONCLUSION TIBS appears to be safe, technically feasible, and clinically effective for patients with malignant biliary obstruction complicated by massive ascites with or without coagulopathy.