Abstract
ObjectivesThe aim of this study was to compare success, technical complexity, and complication rates of percutaneous transhepatic biliary drainage (PTBD) in patients with dilated vs. nondilated bile ducts.MethodsIn a retrospective analysis, we evaluated all consecutive PTBD performed in our department over a period of 5 years. Technical success, technical data (side, fluoroscopy time, radiation dose, amount of contrast media, use of disposable equipment), procedure-related complications and peri-interventional mortality were compared for patients with dilated vs. non-dilated bile ducts. Independent t test and χ2 test were used to evaluate the statistical significance.ResultsA total of 253 procedures were performed on 187 patients, of whom 101/253 had dilated bile ducts and 152/253 not. In total, 243/253 procedures were successful. PTBD was significantly more often successful in patients with dilated vs. nondilated bile ducts (150/153 vs. 93/101; p 0.02). Overall complication rate (13%) did not differ significantly between patients with dilated vs. nondilated bile ducts. Procedures in patients with normal, nondilated bile ducts were associated with a significantly higher rate of post-interventional bleeding (5/101 vs. 0/152). Mean fluoroscopy time (42:36 ± 35:39 h vs. 30:28 ± 25:10 h; p 0.002) and amount of contrast media (66 ± 40 ml vs. 52 ± 24 ml; p 0.07) or use of disposables were significantly higher in patients with nondilated ducts. A significantly lower fluoroscopy time and amount of contrast medium were used in left hepatic PTBD.ConclusionDespite the higher technical complexity, PTBD with nondilated bile ducts was associated with similar overall complication rates but higher bleeding complications compared with PTBD with dilated bile ducts.Key Points• PTBD was associated with similar overall complication rates in patients with dilated vs. nondilated bile ducts.• Although overall complication rates were low, PTBD in patients with nondilated bile ducts was associated with a higher incidence of post-interventional bleeding.• PTBD in patients with nondilated bile ducts is technically more complex.
Highlights
Percutaneous transhepatic biliary drainage (PTBD) is the gold standard treatment for patients in whom endoscopic retrograde cholangiography is unsuccessful or not possible [1,2,3].Eur Radiol (2021) 31:3035–3041The main indication for PTBD is often caused by tumors or inflammatory strictures, leading to cholestasis [4]
Overall complication rates were low, PTBD in patients with nondilated bile ducts was associated with a higher incidence of post-interventional bleeding
An increasing number of PTBD are performed in patients with nondilated bile ducts, mainly to treat postsurgery bile leak in the site of the biliodigestive anastomosis [2, 5, 6]
Summary
Percutaneous transhepatic biliary drainage (PTBD) is the gold standard treatment for patients in whom endoscopic retrograde cholangiography is unsuccessful or not possible [1,2,3].Eur Radiol (2021) 31:3035–3041The main indication for PTBD is often caused by tumors or (post-) inflammatory strictures, leading to cholestasis [4]. An increasing number of PTBD are performed in patients with nondilated bile ducts, mainly to treat postsurgery bile leak in the site of the biliodigestive anastomosis [2, 5, 6]. PTBD in patients with nondilated bile ducts are described to have a higher complication rate and a lower success rate compared with patients with dilated bile ducts [5, 12]. These data are still under debate, with more recent studies suggesting a comparable technical success and complication rate [11]
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