Percutaneous Biliary Drain Placement Research Articles

Abstract No. 315 Software-Based Quantitative Measurement of Drained Liver Volume After Percutaneous Biliary Drain Placement: A Personalized 3D Volumetry Model

Abstract No. 315 Software-Based Quantitative Measurement of Drained Liver Volume After Percutaneous Biliary Drain Placement: A Personalized 3D Volumetry Model

Iatrogenic Complications and Management of Biliary Interventions

AbstractIatrogenic complications can result from both diagnostic and therapeutic hepatobiliary interventions such as percutaneous transhepatic cholangiography, percutaneous biliary drain placement, percutaneous liver biopsy, transarterial liver-directed therapies for malignancy, and liver transplantation. In many of these procedures, the proximity of the biliary ductal system to the hepatic arteries and portal veins predisposes to injury. In other procedures, compromised arterial supply to the biliary system, errors related to complexity of the procedures, or the fragility of the structures themselves may be the root cause. Understanding the etiology of these iatrogenic complications as well as the management options is essential for a multidisciplinary team tasked with managing patients with complex hepatobiliary diseases.

Abstract No. 56 Comparing Outcomes of Percutaneous Biliary Drainage Catheters in Right versus Left Hepatic Approaches

Determine if there is a difference in complications associated with right or left hepatic percutaneous biliary drain placement in patients with benign or malignant biliary etiology. This retrospective study included patients with benign or malignant biliary stricture and treated with percutaneous biliary drainage at a single institution from 7/28/2004 to 3/30/2021. Three hundred fifty-seven patients met inclusion criteria, seventy-seven on the left and two hundred and eighty on the right, with a mean age of 65.1 years. Complications associated with the initial drain placement or during subsequent intervention were collected and categorized. Perioperative complications included surgery, infection, hemorrhage, and drain failure. Complications during treatment with a percutaneous biliary drain included death, chills, catheter displacement, cholangitis, biliary stones, drain malfunction, fever resolving without treatment, and pericatheter leakage. Complications were also grouped as major or minor. Statistical analyses were performed using logistic regression analysis and P values less than 0.05 were considered significant. Major interventional and treatment complication rates showed no statistical significance between left and right drains. The rate of minor interventional and treatment complications also showed no statistical significance between right and left drains. However, when cholangitis was analyzed individually, right sided hepatobiliary drains demonstrated a statistically significant increase in complication rates. Current literature describes safety of right biliary drain placement when compared with left, despite current equivocal study analyses. This large group analysis describes no statistically significant difference in complications between right and left hepatobiliary drains aside from slightly higher incidence of cholangitis for right sided drains.

Plastic biliary stent fracture: A rare complication of percutaneous biliary drain placement

Stent placement at the time of endoscopic retrograde cholangiopancreatography (ERCP) is standard practice for biliary obstruction. While several complications can occur with an indwelling stent, stent fracture is rare. We present a case of plastic biliary stent fracture that occurred at the time of percutaneous biliary drain (PBD) placement as well as the successful endoscopic removal of the fractured stent. Stent fracture should be considered as a possible complication of PBD placement in patients with an indwelling biliary stent.

Prolonged delayed graft function in an orthotopic liver transplantation recipient: a case report

Background: Patients undergoing orthotopic liver transplantation (OLT) can be a considerably complex population to manage post-operatively, as there are several potential complications that can arise during this period, with etiologies ranging from vascular, biliary, immune-mediated, infectious, or other causes. Any of these complications can be responsible for early graft dysfunction or delayed graft function (DGF). In each of these scenarios, the patient must be worked up in a timely manner, in order for the transplant surgeon to determine feasibility to manage the aforementioned complications conservatively, versus returning to the operating room, or even considering relisting the patient for a new organ. Methods: This is a single center, retrospective chart review of a single patient at Hahnemann University Hospital status post OLT demonstrating significantly prolonged DGF over the course of approximately four months. The data was abstracted retrospectively from the inpatient electronic medical record system, CERNER, to include sociodemographic, clinical, and management information. The primary objective of this case report is to describe the clinical and laboratory changes observed in this patient starting from post-operative day one, until normal graft function was achieved, while focusing on the non-surgical interventions performed during this time period. Results: A 56 year old male with a history of end-stage liver disease due to nonalchololic steatohepatitis with cirrhosis underwent OLT, with allograft obtained through donation after cadiac death and with biopsy proven 5 - 10% microsteatosis with no macrosteatosis, and positive hepatitis B virus and CMV serology. His post-operative course was complicated by persistent C. difficile diarrhea treated with antibiotics and eventual fecal transplantation, and multiple bile leaks originally found at the level of the donor cystic duct remnant, and later at the native cystic stump and at the anastomosis. This was reflected in laboratory results as a persistent cholestatic pattern with total bilirubin levels peaking at about 45 mg/dL with direct bilirubin fraction at about 30 mg/dL over one month after OLT. Biopsy of the allograft showed no signs of acute rejection and imaging consistent with normal vasculature and blood flow. This was managed over the course of the first four months post OLT with up to four ERCP procedures with biliary stents placement, and two visits to interventional radiology for percutaneous biliary drain placement due to hepatic collection and bacteremia. Cholestatic laboratory markers started to slowly decrease around week five after OLT, at which point the patient was deemed ready to be discharged to a local rehabilitation center, and finally they were normalized around the four-month mark. No other surgical interventions were performed during this period of time. Conclusion: Post-operative OLT patients are a complex demographic to manage clinically due to a wide array of potential complications, which can manifest either as early graft dysfunction or DGF. During these complications, there is always a question of whether the patient will need a surgical intervention or if a more conservative approach can be used to overcome said complications. This case report highlights how despite initial graft dysfunction post transplantation, demonstrated by abnormal liver function markers, a new graft can potentially achieve normal function even after prolonged periods of time via medical management and non-surgical interventions. This is clinically significant, as this approach could potentially save this fragile population an unnecessary surgical intervention, and/or prevent relisting. Further research is needed investigating this topic.

Predicting Success in Percutaneous Transhepatic Biliary Drainage.

To develop a model to predict successful bilirubin decrease following percutaneous biliary drain placement. A total of 257 patients who were identified having undergone percutaneous transhepatic biliary drain placement (PTBD) at our institution between 2002 and 2013 had their medical records and imaging reviewed. Of those, 190 of these patients met criteria and were used in the analysis. A regression model was performed on logarithm-transformed collected variables to predict post-drainage logarithmic transformed total bilirubin levels. A stepwise variable selection method based on Schwarz Bayesian Information Criterion was used to select the most closely associated variables. The model was validated with a Monte Carlo simulation. A short program was developed to calculate the point estimate using the model developed and compared to actual values. The variables that best predicted bilirubin reduction were initial Tbl (PrTbl), INR and ALT. The selected model had a root mean squared error of 0.8. The model had a negative predictive value (PoTbl is below 2mg/dL) of 83%. PTBD may not achieve decreasing bilirubin in patients with a malignant obstruction. This is an initial model that can help determine which patients may not benefit from PTBD placement. With more patients, the model's validity can be increased and provide useful clinical determinant to aide patient care.

Atypical presentation of herpetic whitlow as dark brown vesicles in a hyperbilirubinemic patient

A 36-year old Caucasian female with a history of metastatic carcinoma of the ovary was hospitalized for a CTguided percutaneous biliary drain placement due to compression of the bile duct by metastases causing severe hyperbilirubinemia. Upon admission the patient mentioned lesions in the left index finger that appeared 12–14 days prior to admission as small tingling reddish vesicles which subsequently grew and darkened. Physical examination was significant for severe jaundice and dark brown vesicular lesions in the left index finger without lymphangitis or lymphadenitis (Fig. 1).

Biliary Venous Fistula after Percutaneous Biliary Drain Placement

Biliary Venous Fistula after Percutaneous Biliary Drain Placement

Management of Bleeding after Percutaneous Transhepatic Cholangiography or Transhepatic Biliary Drain Placement

Bleeding complications occur in 2 to 3% of percutaneous transhepatic biliary drains. These complications include: hemothorax, hemoperitoneum, subcapsular hepatic bleeding, hemobilia, melena, and bleeding from the percutaneous biliary drain. The bleeding sites can be classified into (1) perihepatic bleed sites (hemothorax, hemoperitoneum, subcapsular hepatic hematoma), (2) gastrointestinal bleeding (hemobilia and/or melena), and (3) bleeding from the percutaneous biliary drain itself, which is the most common clinical presentation. There are several bleeding sources. These include skin-bleeds, intercostal artery, portal vein, hepatic vein, and the hepatic artery. There are a variety of maneuvers that can be utilized in the management of bleeding percutaneous biliary drains. These include tractography, angiography, tract embolization, arterial embolization, and tract site changes. This article proposes a protocol for approaching bleeding complications after percutaneous biliary drain placement and details the diagnostic and therapeutic procedures in the management of these bleeding complications.