Biliary obstruction occurs in up to 90% and 56% of patients with pancreatic and gallbladder cancers respectively1. Biliary intervention (BI), stent or drain placement, is a possible treatment, particularly as a bridge to definitive treatment.
Aim: To assess outcomes of BI in inpatients with malignant biliary obstruction and impact of delay in procedure.
Method: Retrospective audit of electronic medical records of Prince of Wales Hospital inpatients who underwent BI for malignant biliary obstruction between 01/01/25 and 12/04/26. Diagnosis of primary malignancy, treatment intent, number of business days between request and procedure, team performing procedure: Gastroenterology/Interventional Radiology, serum bilirubin and time-to-death following procedure were collected. Student’s T-test applied for comparison between groups.
Results: Eleven patients (6 cholangiocarcinoma, 3 pancreatic, 1 gastric and 1 colorectal cancer) underwent 35 procedures. Within 3 months of first BI procedure, 10/11 (91%) died. Three patients had treatment with curative intent (including the patient surviving >3 months). Seven patients received palliative chemotherapy and 1 neoadjuvant chemotherapy. Twelve procedures across 6 patients had a wait of >2 days, with no difference in average wait time (2.2 vs 2.8 business days) between Gastroenterology and Interventional Radiology. BI was associated with bilirubin decrease (average foldchange 0.616 +/- 0.298). No significant difference in mortality nor bilirubin foldchange post intervention was demonstrated in procedures done >2 days vs <2 days of waiting (p=0.383 and p=0.175, respectively). Bilirubin foldchange was not associated with mortality benefit.
Conclusion: While BI resulted in adequate serum bilirubin decrease, it conferred limited survival benefit, with 91% of patients dying within 3 months of intervention. Intervention team, delays in procedure and intent of treatment (curative/palliative) did not influence outcomes in this cohort. Study was limited by a small sample size from one centre. Further study on the selection of patients for BI is warranted.