Successful Biliary Navigation Using Air in Malignant and Post-Surgical Hilar Strictures: A Prospective Controlled Trial

Background and study aim: Patient with biliary obstruction have high risk of cholangitis post ERCP We aimed to compare the feasibility and results of air versus Urographin in biliary navigation.

Patients and methods: From May 2016 to May 2017; 80 patients with hilar stricture were enrolled in this study, they were subdivided into 2 groups with equal number; Air and standard Urographin were used as a contrast in both groups respectively, Klatskin tumor was the most common cause of obstruction. Patients were evaluated at day one, day 7 and day 30 after stent placement.

Results: Successful biliary mapping, stent placement and drainage were achieved in all patients. There was no significant difference in age, gender, clinical presentation, liver function tests, and cause of stricture between both groups; (p > 0.05). Compared with the use of Urographin, more volume of air and longer operative time were observed. The rate of cholangitis and recovery from cholangitis in air group was significantly less than that in Urographin group (5.6% vs. 33.3%, p = 0.04). After ERCP, the mean hospital stay time was shorter in air group compared with control (p < 0.05). The difference of 30 days mortality between two groups was significant (p < 0.05). The X-ray time was significantly less in Urographin group.

Conclusion: Air was safe, costless and effective in biliary navigation for stent placement in hilar biliary strictures regardless the cause.