Complications Of Percutaneous Transhepatic Biliary Drainage Research Articles

Technical Considerations and Complication of Percutaneous Transhepatic Biliary Drainage: A Single Center Retrospective Study

Introduction: With comparable outcomes, percutaneous transhepatic biliary drainage (PTBD) is the preferred method for relieving biliary obstruction when the gold standard endoscopic retrograde cholangiopancreaticography (ERCP) fails or is not practicable.
 Aims & Objectives: To evaluate the technical success rate, clinical success rate, and complications of PTBD.
 Place and duration of study: This study was carried out in Radiology Department of Pakistan Kidney and Liver Institute and Research Center, Lahore, Pakistan from 29th February 2020 to 1st November 2021.
 Material & Methods: In this study, consecutive PTBD procedures performed from 29th February 2020 to 1st November 2021 were retrospectively reviewed. We collected data including patients' age, gender, diagnosis, indications, prior ERCP performance, preoperative and post operative bilirubin, and complications. Technical success, clinical success, and complications were documented. SPSS Version 26 was used for data entry and analysis, P-value<0.05 was taken as significant.
 Results: A total of 96 procedures were performed in 64 patients with the mean age of 52 years (range: 20 - 91 years). Out of 96, 66 (68.8%) procedures were performed in malignant obstruction with most common cause being cholangiocarcinoma (24%). Technical success was achieved in100% of the cases while clinical success rate was 90.6%. In total 96 procedures, 7 complications were reported. Major complication rate was 5.2%. These included 2 cases of post-procedure cholangitis (2.1%), 2 cases of acute pancreatitis (2.1%), and a case of bilio-venous fistula (1%). Minor complication rate (including 2 cases of pericatheter leakage) was 2.1%.
 Conclusion: PTBD is a reliable and effective procedure. In general, complication rate after PTBD is not high, and the patients having malignant disease were more prone to the complications.

Neutrophil-lymphocyte Ratio Predicts Clinical Response to Percutaneous Transhepatic Biliary Drainage in Acute Cholangitis

Predicting response to biliary drainage is critical to stratify patients with acute cholangitis. Total leucocyte count (TLC) is one of the criteria for predicting the severity of cholangitis and is routinely performed. We aim to investigate the performance of neutrophil-lymphocyte ratio (NLR) in predicting clinical response to percutaneous transhepatic biliary drainage (PTBD) in acute cholangitis. This retrospective study comprised consecutive patients with acute cholangitis who underwent PTBD and had serial (baseline, day 1, and day 3) TLC and NLR measurements. Technical success, complications of PTBD, and clinical response to PTBD (based on multiple outcomes) were recorded. Univariate and multivariate analysis was performed to identify factors significantly associated with clinical response to PTBD. The sensitivity, specificity, and area under the curveof serial TLC and NLR for predicting clinical response to PTBD were calculated. Forty-five patients (mean age 51.5 years, range 22-84) met the inclusion criteria. PTBD was technically successful in all the patients. Eleven (24.4%) minor complications were recorded. Clinical response to PTBD was recorded in 22 (48.9%) patients. At univariate analysis, the clinical response to PTBD was significantly associated with baseline TLC (P= 0.035), baseline NLR (P=0.028), and NLR at day 1 (P=0.011). There was no association with age, the presence of comorbidities, prior endoscopic retrograde cholangiopancreatography, admission to PTBD interval, diagnosis (benign vs. malignant), severity of cholangitis, organ failure at baseline, and blood culture positivity. At multivariate analysis, NLR-1 independently predicted the clinical response. Area under the curve of NLR at day 1 for predicting clinical response was 0.901. NLR-1 cut-off value of 3.95 was associated with sensitivity and specificity of 87% and 78%, respectively. TLC and NLR are simple tests that can predict clinical response to PTBD in acute cholangitis. NLR-1 cut-off value of 3.95 can be used in clinical practice to predict response.

Complications of repeated percutaneous transhepatic biliary drainage (PTBD) for palliation of obstructive jaundice in cholangiocarcinoma patient

Background: Cholangiocarcinoma, a malignancy of the biliary duct system, has been recognized as the second most common cause of biliary tract and primary liver malignancies. The incidence has increased in the last three decades worldwide. Percutaneous transhepatic biliary drainage (PTBD) has been considered a highly important palliative therapy for bile duct obstruction due to its high success rate and low incidence of cholangitis. However, bleeding and catheter dislodgment are still found during the procedure. This case discusses the complications of repeated PTBD stent placement as palliative therapy in a patient with obstructive jaundice due to cholangiocarcinoma. Case Presentation: A 58-year-old female presented with a chief complaint of weakness and pain on the right side of the abdomen, particularly at the site of PTBD stent installation three days before being admitted to Dr. Soetomo General Hospital. In 2017, the patient was diagnosed with cholangiocarcinoma­ with obstructive jaundice and had undergone PTBD procedure five times during the period of July 2017 to March 2018 due to biliary leakages. Laboratory investigation indicated elevated bilirubin, decreased potassium, increased random blood sugar, increased blood urea nitrogen, high levels of the 2-hour postprandial blood glucose, and elevated HbA1c, suggesting the conditions of cholangiocarcinoma with obstructive jaundice complicated with hypokalemia, acute kidney injury and type-2 diabetes. The blood smear also indicated normochromic normocytic anisopoikilocytosis anemia and leukocytosis. The patient improved after PTBD replacement, antibiotics treatment, packed red cells transfusion, and rehydration therapy. Conclusion: This case highlights that the complication of PTBD could occur relatively frequently and to prevent the complications in patients with post-PTBD regular medical check-up is therefore recommended. In addition, it is also critical to improve the patient knowledge on how to prevent the bleeding and to avoid the conditions that are potentially increase the chance of catheter dislodgment.

Cholangiocarcinoma With Sepsis Associated With Percutaneous Transhepatic Biliary Drainage (PTBD)

Percutaneous transhepatic biliary drainage (PTBD) can be an alternative palliative treatment in resectable cholangiocarcinoma. One of the most common complications of PTBD is infection, with a prevalence of 3.6 – 67.4% in patients undergoing PTBD procedure, with mortality rate of 0.05-7%. We report a case of a 46-year old male with a history of fever 14 days after undergoing PTBD procedure. Physical examination revealed tachycardia, tachypnea, febris, jaundice, and decreased urine output. Laboratory results revealed hypochromic-microcytic anemia, leukocytosis, decreased renal function, elevated liver enzymes, obstructive icterus, hypoalbuminemia, and hyperkalemia. Blood and gall culture revealed a growth of Eschericia coli. The patient was given fluid resuscitation and antibiotic suitable to microbial sensitivity test, and treatment of acute kidney injury and hyperkalemia, including hemodialysis. The patient’s general condition improved after ten days of care, and was discharged on the twentieth day. Cholangitis is one of the most infectious complications following PTBD procedure. The prevalence of sepsis in biliary drainage procedures was reported 2.5-2.7%, with enteral bacteria gram-negative bacilli being the most common pathogen found in blood and bile. The administration of prophylactic antibiotics was not proven to decrease prevalence of infection. Bacterial translocation via portal vein due to loss of mucosal integrity in the intestines may contribute to bacteremia following PTBD procedure.

Outcome Following Percutaneous Transhepatic Biliary Drainage (PTBD) in Carcinoma Gallbladder: a Prospective Observational Study.

Percutaneous biliary drainage (PTBD) is required as palliation and optimization for surgery or chemotherapy in carcinoma gallbladder (GBC) but may be associated with complications. We aimed to study the outcomes, complications, and changes in quality of life in patients with GBC undergoing PTBD. A prospective study from July 2018 to December 2019 in patients of GBC presenting with obstructive jaundice was done. Patients planned for PTBD were included in the study. The progression of the disease, complications of PTBD, reinterventions, effects on initiation or completion of chemotherapy, surgical resection or intervention, and overall survival were recorded. Quality of life (QoL) was assessed using the SF-36 questionnaire before and after 4-6weeks of intervention. Of 160 patients assessed for inclusion, 60 (mean age 53.7 ± 10.95years, 27 (45%) males) were eventually included. Eleven patients (18.3%) had metastatic disease at presentation. Of 60 patients undergoing PTBD, none had immediate procedure-related complications, 41 (68%) patients had at least one, and 18 (30%) patients had more than one complication. The most common complication was peri-catheter bile leak (41.6%), followed by catheter dislodgement (30%), blockage (23.3%), and bleeding (10%). Reintervention was required in 32 (53%) patients. There was a significant decrease in QoL after PTBD (P < 0.0001). Median survival after PTBD was 12weeks. The high technical success of PTBD does not translate into the improvement of QoL.

Complications of left and right sided percutaneous transhepatic biliary drainage

Background: Percutaneous Transhepatic Biliary Drainage (PTBD) is performed either via right or left-ductal approach, on the basis of status of primary confluence, secondary confluence and atrophy of liver parenchyma. Our study compares the complications of two approaches in malignant obstruction. The objectives of this study was to assess and compare complications of PTBD.Methods: This study was a prospective hospital based study performed for a period of 2 years from 2016 to 2018.PTBD was performed either via right in 16 patients or left-ductal approach in 15 patients, on the basis of status of primary biliary confluence and atrophy of liver parenchyma.Results: Both minor and major complications were more common in right-sided approach as compared to left-sided approach with most common major and minor complication being cholangitis (16.12%) and fever (12.9%) respectively.Conclusions: PTBD is an excellent palliative procedure to drain the bile ducts in malignant obstruction. Although complications of PTBD are more common in right sided approach but results are statistically insignificant.

Clinical correlation of physiological severity (by FFR) and lesion characterization (by IVUS) in non-LMCA intermediate coronary lesions

Percutaneous Transhepatic Biliary Drainage (PTBD) is a procedure indicated in patients with non-operative lesions, when endoscopic application of prosthesis is impossible due to anatomic reasons, complications or severe general condition of patient. Most often it is a palliative procedure, aiming for live-quality improvement, although not altering prognosis of basic disease.This study presents own experience in biliary drainage with the aid of percutaneous transhepatic method and simultaneous assessment of method effectiveness and safety. The aim was to assess outcomes and complications of PTBD in a large group of patients.In time period 2007–2014, 167 patients hospitalized in Radiodiagnostics and Radiology Department of Clinical Hospital, were investigated retrospectively. PTBD procedure was applied to patients with biliary tract obstruction. In total 186 procedures of percutaneous drainage were applied. Average age of patients was 63.6 years. Bilirubin, alkaline phosphatase and gamma-glutamyl transferase were measured before and after procedure. All data were analyzed statistically.In examined group percutaneous drainage was successful in 90.7% interventions. In 8.1% procedures drainage application was ineffective. The most common complication during procedure was hemobilia (3.2%) and the long term complication was drain dislocation (2.7%). The mean bilirubin levels declined from 397.06 μmol/l before drainage to 297.88 μmol/l after drainage (p < 0.05).PTBD is an effective method of biliary tract decompression and it is an important alternative to endoscopic drainage. This method is indicated in patients with neoplastic obstruction of biliary tract with low expected survival rate and thus is a palliative procedure.

Evaluation of complications of PTBD using Hull’s Risk Stratification Index

Introduction: Obstructive jaundice is a common surgical problem. Percutaneous transhepatic biliary drainage (PTBD) is one of the effective treatments in the management of biliary obstruction. Hull Risk stratification index has been proposed to identify which patients are more likely to suffer from immediate and early complications and procedural mortality.Materials and Methods: This is a descriptive observational study conducted at the department of surgery TUTH over a period of 1 year between october 2014 and october 2015. Hull risk stratification index was used to predict the complications of the procedure.Results: 79 patients who underwent PTBD were included during the study period of one year. Among them 39(49%) were male and 40(51%) were female. The median age of patients undergoing the procedure was 59yrs (range 35-90yrs). Twenty nine patients (36%) were in the medium Hull risk group, 50 (64%) of patients were in the low risk group and there were no patients in the high risk group. Six patients (7.5%) died after the procedure. Seven patients (8%) developed sepsis following the procedure. One patient (1.2%) developed hemobilia. Two patients (2.4%) developed pneumonia following the procedure. The sensitivity, specificity, positive predictive value, negative predictive value of the index for complications of PTBD were 81%, 74%, 44% and 94% respectively. Patients with medium Hull’s risk were 3 times more likely to develop complications of PTBD than those with low risk.Conclusion: Hull’s Risk Stratification Index can be utilized as a marker for predicting the early, immediate complications as well as procedure related mortality.