Medical management and endoscopic biliary stenting associated with improved outcomes compared with surgery for extrahepatic biliary duct obstructions in dogs

Objective: To compare short- and long-term clinical outcomes in dogs with extrahepatic biliary duct obstruction (EHBO) managed medically, with endoscopic retrograde cholangiography (ERC)-assisted biliary stenting, or with surgical biliary decompression. Methods: Medical records from 28 client-owned dogs diagnosed with EHBO and treated at a single veterinary referral center between 2012 and 2019 were reviewed retrospectively as part of an observational study. Inclusion criteria included common bile duct dilation (> 3 mm) and clinicopathologic evidence of biliary obstruction. Dogs were grouped based on treatment modality: medical management, ERC (ERC-assisted biliary stenting), or surgery. Outcomes included survival to discharge, median survival time, and complications. Results: 28 dogs were included: 10 medically managed, 12 treated with ERC-assisted biliary stenting, and 6 treated surgically. Survival to discharge was 100% (medical), 92% (ERC), and 33% (surgical). Median survival time was not reached in medical or ERC groups; the surgical group had a median survival time of 4 days. Endoscopic retrograde cholangiography achieved technical success in 86% of cases and had a lower complication rate than surgery. Most dogs managed medically experienced spontaneous resolution of EHBO with supportive care. Pancreatitis as the cause of EHBO was associated with not surviving to discharge. Conclusions: Medical management and ERC-assisted biliary stenting were associated with improved short- and long-term survival rates and fewer complications compared to surgical intervention. Surgical intervention was associated with the highest mortality and complication rates. Clinical Relevance: ERC-assisted biliary stenting and medical management may provide safer alternatives for similar etiologies to surgery for dogs with EHBO, particularly in facilities with interventional endoscopic capabilities. In many cases, supportive care alone may lead to spontaneous resolution of EHBO.