{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T20:39:06Z","timestamp":1790195946166,"version":"4.1.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,5,24]],"date-time":"2024-05-24T00:00:00Z","timestamp":1716508800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,5,24]],"date-time":"2024-05-24T00:00:00Z","timestamp":1716508800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>To assess the outcome of previously untreated patients with perihilar cholangiocarcinoma who present to a cancer referral center with or without pre-existing trans-papillary biliary drainage.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Consecutive patients with a diagnosis of perihilar cholangiocarcinoma presenting between January 1, 2013, and December 31, 2017, were identified from a prospective surgical database and by a query of the institutional database. Of 237 patients identified, 106 met inclusion criteria and were reviewed. Clinical information was obtained from the Electronic Medical Record and imaging studies were reviewed in the Picture Archiving and Communication System.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>73 of 106 patients (69%) presenting with a new diagnosis of perihilar cholangiocarcinoma underwent trans-papillary biliary drainage (65 endoscopic and 8 percutaneous) prior to presentation at our institution. 8 of the 73 patients with trans-papillary biliary drainage (11%) presented with and 5 developed cholangitis; all 13 (18%) required subsequent intervention; none of the patients without trans-papillary biliary drainage presented with or required drainage for cholangitis (<jats:italic>p<\/jats:italic>\u2009=\u20090.008). Requiring drainage for cholangitis was more likely to delay treatment (<jats:italic>p<\/jats:italic>\u2009=\u20090.012) and portended a poorer median overall survival (13.6 months, 95%CI [4.08, not reached)] vs. 20.6 months, 95%CI [18.34, 37.51] <jats:italic>p<\/jats:italic>\u2009=\u20090.043).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Trans-papillary biliary drainage for perihilar cholangiocarcinoma carries a risk of cholangitis and should be avoided when possible. Clinical and imaging findings of perihilar cholangiocarcinoma should prompt evaluation at a cancer referral center before any intervention. This would mitigate development of cholangitis necessitating additional drainage procedures, delaying treatment and potentially compromising survival.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12876-024-03241-8","type":"journal-article","created":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T23:02:48Z","timestamp":1716505368000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Outcome of patients with perihilar cholangiocarcinoma and previous biliary instrumentation: an observational study"],"prefix":"10.1186","volume":"24","author":[{"given":"Karen T.","family":"Brown","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne F.","family":"Chou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah B.","family":"Suchy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George I.","family":"Getrajdman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mithat","family":"Gonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne M.","family":"Covey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn A.","family":"Brody","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Schattner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael I.","family":"D\u2019Angelica","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. Peter","family":"Kingham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph P.","family":"Erinjeri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William R.","family":"Jarnagin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,5,24]]},"reference":[{"issue":"5","key":"3241_CR1","first-page":"1159","volume":"11","author":"HR Shin","year":"2010","unstructured":"Shin HR, Oh JK, Masuyer E, Curado MP, Bouvard V, Fang Y, et al. Comparison of incidence of intrahepatic and extrahepatic cholangiocarcinoma\u2013focus on East and South-Eastern Asia. Asian Pac J cancer Prevention: APJCP. 2010;11(5):1159\u201366.","journal-title":"Asian Pac J cancer Prevention: APJCP"},{"key":"3241_CR2","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1016\/B978-1-4377-1454-8.00111-9","volume-title":"Blumgart\u2019s surgery of the liver, biliary tract and pancreas","author":"MGDAM House","year":"2012","unstructured":"House MGDAM, Jarnagin WR. Cancer of the bile ducts: extrahepatic biliary tumors. In: Jarnagin WR, editor. Blumgart\u2019s surgery of the liver, biliary tract and pancreas. 1 5th ed. Philadelphia: Elsevier; 2012. pp. 771\u201388.","edition":"1 5"},{"issue":"4","key":"3241_CR3","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1002\/ags3.12181","volume":"2","author":"ME Lidsky","year":"2018","unstructured":"Lidsky ME, Jarnagin WR. Surgical management of hilar cholangiocarcinoma at Memorial Sloan Kettering Cancer Center. Ann Gastroenterol Surg. 2018;2(4):304\u201312.","journal-title":"Ann Gastroenterol Surg"},{"key":"3241_CR4","doi-asserted-by":"crossref","unstructured":"Ellis RJ, Soares KC, Jarnagin WR. Preoperative Management of Perihilar Cholangiocarcinoma. Cancers (Basel). 2022;14(9).","DOI":"10.3390\/cancers14092119"},{"issue":"4","key":"3241_CR5","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1016\/S1051-0443(98)70324-0","volume":"9","author":"LA Brody","year":"1998","unstructured":"Brody LA, Brown KT, Getrajdman GI, Kannegieter LS, Brown AE, Fong Y, et al. Clinical factors associated with positive bile cultures during primary percutaneous biliary drainage. J Vasc Interv Radiol. 1998;9(4):572\u20138.","journal-title":"J Vasc Interv Radiol"},{"issue":"4","key":"3241_CR6","doi-asserted-by":"publisher","first-page":"E427","DOI":"10.1055\/s-0042-102246","volume":"4","author":"K Kubota","year":"2016","unstructured":"Kubota K, Hasegawa S, Iwasaki A, Sato T, Fujita Y, Hosono K, et al. Stent placement above the sphincter of Oddi permits implementation of neoadjuvant chemotherapy in patients with initially unresectable klatskin tumor. Endosc Int Open. 2016;4(4):E427\u201333.","journal-title":"Endosc Int Open"},{"key":"3241_CR7","doi-asserted-by":"crossref","unstructured":"Hosmer DWLS. Applied Logistic Regression, Second Edition. New York, NY: John Wiley and Sons, Inc.; 2000.","DOI":"10.1002\/0471722146"},{"issue":"1","key":"3241_CR8","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.jvir.2011.09.022","volume":"23","author":"RH Thornton","year":"2012","unstructured":"Thornton RH, Ulrich R, Hsu M, Moskowitz C, Reidy-Lagunes D, Covey AM, et al. Outcomes of patients undergoing percutaneous biliary drainage to reduce bilirubin for administration of chemotherapy. J Vasc Interv Radiol. 2012;23(1):89\u201395.","journal-title":"J Vasc Interv Radiol"},{"issue":"4","key":"3241_CR9","doi-asserted-by":"publisher","first-page":"795","DOI":"10.2214\/AJR.11.6424","volume":"197","author":"DI Gwon","year":"2011","unstructured":"Gwon DI, Ko GY, Sung KB, Yoon HK, Shin JH, Hyoung Kim J, et al. Percutaneous biliary metallic stent placement in patients with unilobar portal vein occlusion caused by advanced hilar malignancy: outcome of unilateral versus bilateral stenting. AJR Am J Roentgenol. 2011;197(4):795\u2013801.","journal-title":"AJR Am J Roentgenol"},{"issue":"2","key":"3241_CR10","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/j.jamcollsurg.2016.03.035","volume":"223","author":"JK Wiggers","year":"2016","unstructured":"Wiggers JK, Groot Koerkamp B, Cieslak KP, Doussot A, van Klaveren D, Allen PJ, et al. Postoperative mortality after liver resection for Perihilar Cholangiocarcinoma: development of a risk score and importance of biliary drainage of the Future Liver Remnant. J Am Coll Surg. 2016;223(2):321\u201331. e1.","journal-title":"J Am Coll Surg"},{"issue":"12","key":"3241_CR11","doi-asserted-by":"publisher","first-page":"1124","DOI":"10.1055\/s-0034-1392559","volume":"47","author":"JK Wiggers","year":"2015","unstructured":"Wiggers JK, Groot Koerkamp B, Coelen RJ, Rauws EA, Schattner MA, Nio CY, et al. Preoperative biliary drainage in perihilar cholangiocarcinoma: identifying patients who require percutaneous drainage after failed endoscopic drainage. Endoscopy. 2015;47(12):1124\u201331.","journal-title":"Endoscopy"},{"issue":"4","key":"3241_CR12","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1111\/jgh.12128","volume":"28","author":"R Rerknimitr","year":"2013","unstructured":"Rerknimitr R, Angsuwatcharakon P, Ratanachu-ek T, Khor CJ, Ponnudurai R, Moon JH, et al. Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma. J Gastroenterol Hepatol. 2013;28(4):593\u2013607.","journal-title":"J Gastroenterol Hepatol"},{"issue":"6","key":"3241_CR13","doi-asserted-by":"publisher","first-page":"1267","DOI":"10.1002\/jso.24945","volume":"117","author":"XF Zhang","year":"2018","unstructured":"Zhang XF, Beal EW, Merath K, Ethun CG, Salem A, Weber SM, et al. Oncologic effects of preoperative biliary drainage in resectable hilar cholangiocarcinoma: percutaneous biliary drainage has no adverse effects on survival. J Surg Oncol. 2018;117(6):1267\u201377.","journal-title":"J Surg Oncol"},{"issue":"2","key":"3241_CR14","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1016\/j.surg.2016.08.008","volume":"161","author":"K Komaya","year":"2017","unstructured":"Komaya K, Ebata T, Yokoyama Y, Igami T, Sugawara G, Mizuno T, et al. Verification of the oncologic inferiority of percutaneous biliary drainage to endoscopic drainage: a propensity score matching analysis of resectable perihilar cholangiocarcinoma. Surgery. 2017;161(2):394\u2013404.","journal-title":"Surgery"},{"issue":"1","key":"3241_CR15","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1111\/den.12320","volume":"27","author":"XQ Zhao","year":"2015","unstructured":"Zhao XQ, Dong JH, Jiang K, Huang XQ, Zhang WZ. Comparison of percutaneous transhepatic biliary drainage and endoscopic biliary drainage in the management of malignant biliary tract obstruction: a meta-analysis. Dig Endosc. 2015;27(1):137\u201345.","journal-title":"Dig Endosc"},{"issue":"10","key":"3241_CR16","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1016\/S2468-1253(18)30234-6","volume":"3","author":"RJS Coelen","year":"2018","unstructured":"Coelen RJS, Roos E, Wiggers JK, Besselink MG, Buis CI, Busch ORC, et al. Endoscopic versus percutaneous biliary drainage in patients with resectable perihilar cholangiocarcinoma: a multicentre, randomised controlled trial. Lancet Gastroenterol Hepatol. 2018;3(10):681\u201390.","journal-title":"Lancet Gastroenterol Hepatol"},{"issue":"4","key":"3241_CR17","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1016\/j.jvir.2016.12.1218","volume":"28","author":"A Al Mahjoub","year":"2017","unstructured":"Al Mahjoub A, Menahem B, Fohlen A, Dupont B, Alves A, Launoy G, et al. Preoperative biliary drainage in patients with Resectable Perihilar Cholangiocarcinoma: is percutaneous transhepatic biliary drainage Safer and more effective than endoscopic biliary drainage? A Meta-analysis. J Vasc Interv Radiol. 2017;28(4):576\u201382.","journal-title":"J Vasc Interv Radiol"},{"issue":"1","key":"3241_CR18","doi-asserted-by":"publisher","first-page":"133","DOI":"10.5604\/16652681.1226927","volume":"16","author":"D Waseem","year":"2017","unstructured":"Waseem D, Tushar P. Intrahepatic, perihilar and distal cholangiocarcinoma: management and outcomes. Ann Hepatol. 2017;16(1):133\u20139.","journal-title":"Ann Hepatol"},{"issue":"8","key":"3241_CR19","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1016\/j.jvir.2019.03.001","volume":"30","author":"HF Zhou","year":"2019","unstructured":"Zhou HF, Huang M, Ji JS, Zhu HD, Lu J, Guo JH, et al. Risk prediction for early biliary infection after percutaneous transhepatic biliary stent Placement in malignant biliary obstruction. J Vasc Interv Radiol. 2019;30(8):1233\u201341. e1.","journal-title":"J Vasc Interv Radiol"},{"key":"3241_CR20","doi-asserted-by":"publisher","first-page":"1849","DOI":"10.1016\/j.jvir.2020.07.015","volume":"31","author":"AM Devane","year":"2020","unstructured":"Devane AM, Annam A, Brody L, Gunn AJ, Himes EA, Patel S, et al. Society of Interventional Radiology Quality Improvement Standards for percutaneous cholecystostomy and transhepatic biliary interventions. J Vasc Interv Radiol. 2020;31:1849\u201356.","journal-title":"J Vasc Interv Radiol"}],"container-title":["BMC Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-024-03241-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12876-024-03241-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-024-03241-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T23:02:52Z","timestamp":1716505372000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcgastroenterol.biomedcentral.com\/articles\/10.1186\/s12876-024-03241-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,24]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["3241"],"URL":"https:\/\/doi.org\/10.1186\/s12876-024-03241-8","relation":{},"ISSN":["1471-230X"],"issn-type":[{"value":"1471-230X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,24]]},"assertion":[{"value":"15 August 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 April 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 May 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed in accordance with the Declaration of Helsinki and was granted an exemption from ethics approval by the Institutional Review Board (IRB) at Memorial Sloan Kettering Cancer Center. No individual personal data was used in preparing this manuscript and consent from the patients studied was not required by the IRB given the retrospective nature of the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"181"}}