Patients with pancreatic cancer who underwent endoscopic drainage had fewer adverse events than those who underwent percutaneous drainage, according to a study published online ahead of print in JAMA Oncology.1

However, endoscopic drainage in patients with cholangiocarcinoma was superior only in centers that performed few percutaneous biliary drainage procedures.

Researchers sought to determine the rates of procedure-related adverse events during nonsurgical biliary drainage in malignant biliary tract obstruction. Rates of adverse events due to endoscopic retrograde cholangiopancreatography (ERCP) were compared with percutaneous transhepatic biliary drainage (PTBD).

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A total of 7,445 patients (ERCP) and 1,690 (PTBD) were included in this retrospective analysis, which included patients from the National Inpatient Sample database from 2007 through 2009, and was representative of the US population.

Results showed the overall adverse event rate for endoscopic drainage was 8.6% and 12.3% for percutaneous biliary drainage (P < .001).

When analyzed by type of neoplasm, patients with pancreatic cancer experienced a lower rate of adverse events with ERCP when compared with PTBC (2.9% vs 6.2; odds ratio [OR], 0.46; 95% CI, 0.35 – 0.61; P < .001). 

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Patients with cholangiocarcinoma who had the procedure done at a center that performed a low volume of percutaneous biliary drainage procedures were more likely to experience adverse events compared with endoscopic procedures performed at the same center (5.7% vs 2.5%; OR, 2.28; 95% CI, 1.02 – 5.11; P = .04). Centers that performed a high volume of percutaneous procedures had rates comparable to those with endoscopic procedures.


  1. Inamdar S, Slattery E, Bhalla R, et al. Comparison of adverse events for endoscopic vs percutaneous biliary drainage in the treatment of malignant biliary tract obstruction in an inpatient national cohort [published online ahead of print October 29, 2015]. JAMA Oncol. doi: 10.1001/jamaoncol.2015.3670.