Clinical outcomes of hepaticojejunostomy and ERCP endoscopic bile duct stent implantation in the treatment of malignant obstructive jaundice: a retrospective analysis

Purpose Malignant obstructive jaundice (MOJ) refers to intrahepatic or extrahepatic bile ducts obstruction caused by the compression or infiltrative growth of malignant tumors, followed by cholestasis and jaundice. Hepaticojejunostomy (HJ) and Endoscopic Retrograde Cholangiopancreatography (ERCP) bile duct stent implantation are the common palliative treatment to reduce jaundice. The aim of current research was to investigate which treatment was better for patients with MOJ. Patients and methods: A retrospective analysis of 171 patients with distal bile duct obstruction due to malignancy admitted to the Department of Hepatobiliary Surgery and Gastroenterology in our hospital from February 2013 to August 2021. According to different treatment options, patients were divided into ERCP group (n = 64) and HJ group (n = 107). The primary end point was overall survival (OS); the secondary end points were postoperative bilirubin level, hospitalization time, recurrence time of obstructive jaundice, and the occurrence of recent postoperative complications. Results In this study, we found that There was no significant difference in the median OS between the ERCP group and the HJ group [mOS: 11.6 (95%CI9.4-13.8) months vs 13.3 (95%CI10.7-15.9) months, P = 0.978]. There was no statistical difference in the effect of reducing jaundice between the two groups (P > 0.05). The average hospitalization time in the ERCP group was 6.67 ± 4.02 days, which was significantly shorter than that in the HJ group (9.56 ± 5.38 days, P < 0.001). There was no significant difference in the total incidence of postoperative complications in the ERCP group compared with the HJ group (21.9% vs 21.5%, P = 0.953). However, pancreatitis often occurred in the ERCP group (P = 0.036). In terms of complications of biliary fistula, it mainly occurred in the HJ group (P = 0.029). Compared with the ERCP group, the recurrence time of obstructive jaundice was longer in the HJ group (P = 0.007). Conclusion This study showed that both treatments can effectively reduce bilirubin and improve liver function in patients with distal bile duct obstruction due to malignancy. Considering the long-term effect, HJ is superior to ERCP bile duct stenting.