Sclerosing cholangitis due to intra-arterial hepatic infusion with chemotherapy: Management with non-surgical biliary drainage
ABO Blood-Group System
Genetic Predisposition to Disease
Genome-Wide Association Study
To assess the role of biliary drainage in the management of jaundiced patients with sclerosing cholangitis due to intrahepatic infusion with floxuridine (FUDR), we retrospectively reviewed the charts of all patients receiving such treatment at Memorial Sloan Kettering Cancer Center between 1985 and 1990. Of 206 patients treated, 67(32 %) patients had an elevation of bilirubin to more than 3 mg/dl (normal 1.5 mg/dl) during the course of treatment, but only twenty (10 %) patients had persistent elevation of bilirubin (range 4-52 mg/dl) requiring evaluation with endoscopic retrograde cholangiopancreatogram (ERCP) and/or transhepatic cholangiogram. Thirteen patients (6 %) were found to have sclerosing cholangitis and seven had cholangiographic findings consistent with biliary obstruction from progressive metastatic liver disease. In all 13 patients with sclerosing cholangitis, biliary drainage was attempted by either endoscopic, percutaneous or combined approach and was successful in 11. Although all patients with sclerosing cholangitis had an initial tumor response to infusional chemotherapy, only five patients continued to have a partial response at the time of biliary drainage and the remaining six had evidence of minor disease progression. Biliary drainage was successful in lowering bilirubin levels to normal values in 4/5 patients who had tumor response at the time of drainage and in 1/6 patients with tumor progression. Ten of eleven drained patients (91 %) had at least one episode of cholangitis requiring hospitalization (range 1 to 4 episodes per patient). We conclude, in patients with sclerosing cholangitis due to hepatic arterial infusion of FUDR, biliary drainage will improve liver function tests and lower serum bilirubin levels when performed in the setting of tumor response. The impact of biliary drainage in these patients on survival cannot be assessed without a prospective randomized trial.