Palliative drainage in unresectable malignant hilar bilary obstruction: does the rate of post-interventional acute pancreatitis increase with the number of transpapillary stent? ; Drainage biliaire palliatif dans les sténoses hilaires malignes : le taux de pancréatites aiguës post-interventionnelles augmente-t-il avec le nombre de prothèses transpapillaires ?

Introduction: For several years, we have been trying to determine the optimal strategy for unresectable malignant hilar bilary obstruction (UMHBO) biliary drainage. While optimal liver drainage is becoming standard in high-volume teams, the question of drainage technique remains open. The ESGE recommends biliary drainage by ERCP for Klastkin type I and II, and percutaneous drainage alone or combined with ERCP for Klastkin III and IV. We aimed to assess the relationship between the number of transpapillary biliary stents used and the incidence of post-procedural acute pancreatitis in these patients. Patients and methods: We retrospectively included patients hospitalised for drainage of UMHBO between January 2015 and August 2022 in our centre (Institut Paoli-Calmettes, Marseille, France). The primary outcome was to evaluate the rate of post-procedural acute pancreatitis as a function of the number of transpapillary stents placed. Secondary outcomes were to assess patient survival as a function of the percentage of liver drained and to analyse the safety profile of each drainage procedure. Results: 312 patients were included. Analysis showed a significant increase (p-value = 0.005) in the rate of acute pancreatitis according to the number of transpapillary stents inserted, with respective rates of (5.3%), (6.9%), (18.4%) and (20%) for 1, 2, 3 and 4 transpapillary stents. Analysis of survival as a function of the percentage of liver drained showed a significant improvement in survival for drainage of 75 to 100% of the viable liver (p < 0.01). The techniques associated with the lowest morbidity rates were echo-endoscopy alone, with a rates of 18.18%, and echo-endoscopy combined with endoscopy, with a rate of 28%. Discussion: It appears that placement of multiple transpapillary biliary stents for drainage of UMHBO increases the rate of acute pancreatitis. The combination of echo-endoscopy and ERCP could reduce this risk in the drainage of complex type III and IV strictures. ; Introduction : Depuis plusieurs années, ...