Abstract No. 55 Evaluating Percutaneous Transhepatic Biliary Drainage (PTBD) Factors Associated with Better Outcomes in the Treatment of Post-Surgical Benign Biliary Strictures

Abstract

To report outcomes of post-surgical benign biliary strictures treated with percutaneous transhepatic biliary drainage (PTBD) and balloon dilation. Patients with a history of surgery and who developed a benign biliary stricture were included in this retrospective, IRB-approved study (n = 44). Patients having biliary leaks, or with complete occlusion of the bile duct due to surgical clips were excluded (n = 28). Drain size, type (internal-external or external), balloon dilation, and type and size of balloon used was evaluated for all biliary procedures. These characteristics were compared between patients needing (n = 8) and not needing (n = 36) surgical revision. Continuous variables are reported as median (IQR) and compared with Wilcoxon rank sum test, categorical variables as numbers with percentages and compared using chi-square test. Patients were 59 (42-67) years old with 67% being female. Hepaticojejunostomy was the most common surgery (30%) followed by Roux-en-Y gastric bypass (16%), pancreaticoduodenectomy (14%), transplant (14%), Billroth II (9%), cholecystectomy (7%) and others (9%). Duct to enteric anastomosis was present in 52%, duct to duct in 11% and no anastomosis in 36%. Prior non-PTBD interventions included ERCP dilation and stent placement in 9 (20%) and failed ERCP in 10 (23%) patients. The first PTBD was done 28 (6-98) months after surgery, with a drain size of ≥10F in 20 (45%) and < 10F in 24 (55%) patients. The drain was internal-external in 41 (93%) patients. Patients underwent a total of 4 (3-8) procedures before drain removal, with drain upsizing performed in 23 (52%) patients, leading to a largest drain size of ≤8F in 10 (23%), 10F in 17 (39%), 12F in 14 (32%) and ≥14F in 3 (6%) patients. Balloon dilation was performed in 40 (91%) patients, with the largest balloon size being ≤8 mm in 13 (30%), 10 mm in 20 (45%), 12 mm in 6 (14%), and 14 mm in 1 (2%) patient. A cutting balloon was used in 19 (43%) patients. Surgical revision was needed in 8 (18%) patients, with a repeat PTBD performed in 5 (11%) patients. The rate of surgical revision was lower in patients who received a largest drain of ≥10F (12%) compared with those who received a largest drain of <10F (40%, P = 0.042). The rate of surgical revision was 7.4% in patients who were dilated with a balloon of ≥10 mm compared with 30.7% in those who were dilated with a balloon of <10 mm (P = 0.053). The median drain-free survival was 41 (11-57) months for the entire cohort. Postsurgical benign biliary strictures treated with PTBD with a drain of ≥10F and dilated with a balloon of ≥10 mm are less likely to need surgical revision.