Endoscopic Biliary Drainage by ERCP in the Management of Malignant Biliopancreatic Strictures: A Six-Year Single-Center Retrospective Study

Abstract

Background: Malignant biliopancreatic strictures are a major cause of obstructive jaundice and are frequently associated with advanced pancreatic and biliary malignancies. Endoscopic retrograde cholangiopancreatography (ERCP) with biliary drainage remains the preferred palliative and therapeutic intervention for restoring bile flow, relieving symptoms, and facilitating further oncological management. Aims: The study aims to evaluate the technical performance, early safety profile, and short-term clinical contribution of endoscopic biliary drainage by endoscopic retrograde cholangiopancreatography (ERCP) in patients with malignant biliopancreatic strictures. Study Design: Retrospective, single-center, descriptive observational study. Place and Duration of Study: Department of Gastroenterology I, Mohammed V Military Teaching Hospital, Rabat, Morocco, between January 2020 and December 2025. Methodology: Consecutive patients who underwent ERCP for confirmed malignant biliopancreatic stricture were reviewed. Demographic, clinical, biological, radiological, endoscopic, stenting, complication, rescue drainage, and one-month outcome data were extracted from standardized medical records. Technical success was defined as successful completion of ERCP with effective endoscopic biliary drainage. Results: Among 140 screened patients, 78 met the inclusion criteria. Mean age was 66 years, and 58 patients were male (74.3%). Cholestatic jaundice was present in all patients, while weight loss and abdominal pain were each reported in 56 patients (71.8%). The main etiologies were pancreatic cancer (43.6%) and cholangiocarcinoma (20.5%). ERCP was technically successful in 64 patients (82.05%). Distal common bile duct strictures predominated (53%). Plastic stents were used in 32 patients (50%), uncovered self-expandable metal stents in 28 (43.75%), and mixed plastic-metal stenting in 4 (6.25%). Immediate post-procedure evolution was uncomplicated in 48 patients (75%). Early complications included cholangitis, post-ERCP pancreatitis, bleeding, and perforation. Conclusion: ERCP-based biliary drainage was feasible and clinically useful in this Moroccan tertiary-care cohort, with acceptable technical success and early morbidity. Earlier referral, systematic risk reduction, appropriate stent selection, and multidisciplinary rescue pathways after failed ERCP are essential to optimize outcomes.