Percutaneous Transhepatic Biliary Drainage Catheter Research Articles

Removal of a broken percutaneous transhepatic biliary drainage catheter by cholangioscopy through a lumen-apposing metal stent used for choledochoduodenostomy.

Removal of a broken percutaneous transhepatic biliary drainage catheter by cholangioscopy through a lumen-apposing metal stent used for choledochoduodenostomy.

Predictive Factors for Symptomatic Dislodgement of Percutaneous Transhepatic Biliary Drainage Catheter in Patients with Malignant Biliary Obstruction.

To evaluate the factors that predict symptomatic dislodgement of a percutaneous transhepatic biliary drainage (PTBD) catheter in patients with malignant biliary obstruction. This retrospective study included 572 patients with malignant biliary obstruction who underwent 733 PTBD catheter insertions between January 2010 and February 2015. The duration of catheter placement, approach site, location of the catheter tip, insertion angle, presence of a closed-loop pigtail, and tube diameter were evaluated. During the follow-up period, 224 PTBD catheter dislodgements (30.56%) were observed in 157 patients. Among them, 146 (19.92%) were symptomatic. The mean duration from catheter insertion until dislodgement was 32 days (range: 1-233 days). Male (odds ratio [OR]: 1.636, 95% confidence interval [CI]: 1.131-2.367, p = 0.009), right-sided approach (OR: 1.567, 95% CI: 1.080-2.274, p = 0.018), increased insertion angle (OR: 1.015, 95% CI: 1.005-1.026, p = 0.005), and incomplete closed-loop pigtail formation (OR: 1.672, 95% CI: 1.098-2.545, p = 0.016) were independent factors predictive of symptomatic dislodgement of a PTBD catheter. Factors predictive of symptomatic catheter dislodgement included male sex, a right-sided approach, increased insertion angle, and incomplete closed-loop pigtail formation.

Myiasis of a Percutaneous Biliary Drainage Site

A 62-year-old woman with unresectable gall bladder carcinoma presented with a dislodged right percutaneous transhepatic biliary drainage (PTBD) catheter placed 5 weeks earlier at another hospital. Ultrasound examination of the abdomen revealed a gall bladder fossa mass with mild intrahepatic biliary dilatation. Upon removal of the bile-soaked dressing, an unusual appearance of the PTBD site tissue was noted (Fig a). Upon closer examination, multiple larvae were found crawling within the PTBD site (Fig b).

Percutaneous Balloon Retrieval Technique for Fractured Biliary Drainage Catheter in a Paediatric Patient: Can a Major Surgery be Averted?

Percutaneous Transhepatic Biliary Drainage (PTBD) involves temporary placement of an external drainage catheter into an obstructed bile duct prior to internal biliary stenting or surgery. Chronic indwelling PTBD catheters can develop surrounding adhesions and are prone to fractures and retention during their removal. Retained segments can cause impaired biliary drainage, inflammation and recurrent cholangitis. Retrieval of retained catheters can be done by endoscopic/surgical/percutaneous techniques. In patients who have undergone Hepatico-Jejunostomy (HJ), endoscopic removal is not possible and percutaneous/surgical removal are the only options. The authors present a case of a five-year-old child who came for removal of a fractured, retained PTBD catheter, nine months after undergoing HJ. The catheter was removed by a percutaneous balloon retrieval technique. The objective here is to highlight the technical challenges encountered and present a modification of the usual balloon retrieval technique used to successfully remove the catheter and thus avert a major surgery.

Cholangioscopy and double-balloon enteroscopy mediated "sandwich puncture" of a completely closed choledochojejunostomy.

Video 1Percutaneous cholangioscopy was performed to confirm complete closure of the choledochojejunostomy. Percutaneous cholangioscopy revealed complete closure of the anastomosis. Our attempt to pass a guidewire through the anastomosis failed accordingly.

Ultrasonographically guided percutaneous transhepatic liver biopsy after pediatric liver transplantation.

Complications associated with ultrasonographically guided percutaneous transhepatic liver biopsy (PTLB) after liver transplantation (LT) have been rarely reported, and there is no consensus about its safety. We retrospectively reviewed the safety and outcomes of PTLB after pediatric LT. Between January 2008 and December 2019, 8/1122 (0.71%) pediatric patients who underwent ultrasonographically guided PTLB after LT developed complications. The median age at PTLB was 7.8years (range 0.1-17.9). Grafts included left lobe/left lateral segment in 1050 patients and others in 72. PTLB was performed using local anesthesia±sedation in 1028 patients and general anesthesia in 94. Complications after PTLB included acute cholangitis in 3 patients, sepsis in 2, respiratory failure due to over-sedation in 1, subcapsular hematoma in 1, and intrahepatic arterioportal fistula in 1. The incidence of complications of PTLB in patients with biopsy alone and those with simultaneous interventions was 0.49% and 3.19%, respectively (p=.023). Patients who developed acute cholangitis, respiratory failure, subcapsular hematoma, and arterioportal fistula improved with non-operative management. Of two patients with sepsis, one underwent PTLB and percutaneous transhepatic portal vein balloon dilatation and developed fever and seizures the following day. Sepsis was treated with antibiotic therapy. Another patient who underwent PTLB and exchange of percutaneous transhepatic biliary drainage catheter developed fever and impaired consciousness immediately. Sepsis was treated with antibiotic therapy, mechanical ventilation, and continuous hemofiltration. Percutaneous transhepatic liver biopsy after pediatric LT is safe. However, combining liver biopsy with simultaneous procedures for vascular and biliary complications is associated with an increased risk of complications.

3:18 PM Abstract No. 101 30-day readmission rates following percutaneous transhepatic biliary drainage catheter placement

To retrospectively analyze all-cause 30-day readmission rates for patients undergoing percutaneous transhepatic biliary drainage catheter (PTBD) placement. Prior literature has suggested high complication rates following PTBD placement. A total of 238 PTBD procedures for 212 patients over a 5-year period from a single institution were retrospectively reviewed from the electronic health record. Variables analyzed included number of days to readmission following discharge from index admission, reason for readmission, and whether readmission was planned or unplanned and IR- or non-IR related. Additional variables analyzed included demographic data, etiology of biliary obstruction, laterality of access, and initial catheter size. The number of days to 30-day readmission post discharge ranged from 2 to 28 days, with a mean of 12.9 days. Of the 67 readmissions, 36 (53.7%) were secondary to malignant and 31 (46.3%) were for benign obstruction. Causes of IR-related readmission were suspected cholangitis (48.5%), leakage or drainage around catheter exit site (27.3%), drain malposition/malfunction (9.1%), and right upper quadrant abdominal pain (6.1%). See table below. PTBD procedures for both benign and malignant disease are associated with high rates of 30-day readmissions, a significant number of which are unplanned and IR-related. This has major implications on quality, safety, and reimbursement and implies the potential for improved post procedure care following PTBD procedures in order to reduce readmission rates.Tabled 1Total number of primary PTBD procedures238Malignant obstruction122 (51.3%)Benign obstruction116 (48.7%)All-cause 30-day readmission67 (28.2%)IR-related readmissions33 (49.3% of readmissions; 13.9% of total)Unplanned IR-related readmissions30 (90.9% of IR-related readmissions; 12.6% of total) Open table in a new tab

4:12 PM Abstract No. 107 Postprocedural care for patients receiving percutaneous transhepatic biliary drainage catheter placement

4:12 PM Abstract No. 107 Postprocedural care for patients receiving percutaneous transhepatic biliary drainage catheter placement

A case of small in situ perihilar cholangiocarcinoma incidentally accompanied by benign bile duct stricture after open cholecystectomy

BackgroundIn situ cholangiocarcinoma is difficult to detect by imaging studies. Thus, cholangiocarcinoma is rarely resected with a preoperative definitive diagnosis, especially nonpapillary flat type in situ carcinoma, which is extremely rare.Case presentationA 70-year old man was diagnosed with gallbladder cancer and received open cholecystectomy with lymphadenectomy at a local hospital. Histologically, the tumor was localized in the mucosal layer, and no lymph node metastases were found. Three months later, hilar bile duct stricture due to delayed bile duct ischemia was found. Then, biliary drainage was performed with endoscopic biliary stenting. Three months later, the patient experienced cholangitis with septic shock, and percutaneous transhepatic biliary drainage (PTBD) into the left intrahepatic bile duct was performed. Unexpectedly, the aspiration bile cytology of the PTBD catheter showed malignant cells, and the patient was referred to our clinic for possible surgical treatment. According to additional studies, the hilar bile duct stricture was 3 cm in length. None of the imaging studies detected malignant cells in the bile duct around the hilar stricture. The left portal vein was obstructed due to inadvertent puncture of the PTBD. No findings indicated cholangiocarcinoma. We performed left hepatectomy with caudate lobectomy and extrahepatic bile duct resection. The postoperative course was uneventful. In the final pathology, flat type in situ carcinoma was found at the confluence of the right and left hepatic ducts, which was distant from the biliary stricture.ConclusionsWhen a tumor is undetectable but cytology is positive, in situ cholangiocarcinoma may exist; thus, surgery should be carefully considered.

The elements of fluid mechanics of bile flow through biliary drainage catheters

Obstructive jaundice in the biliary tract can infect blood and result in mortality with a high rate. Percutaneous transhepatic biliary drainage (PTBD) with catheters is a useful solution discharging the obstructive jaundice. However, the elements of fluid mechanics showing clinical performance of a PTBD catheter have been documented little so far. In the article, empirical relationships between bile flow rate and pressure gradient in PTBD catheters were studied in terms of equivalent friction factor for the first time. Firstly, an equivalent friction factor in a catheter was raised and determined based on existing in vitro experimental data of bile flow through the catheters with different materials, various inner diameters and lengths under various pressure differences. Then, an empirical correlation of bile flow rate through a catheter was established based on pressure gradient, inner diameter and bile viscosity. The correlation was used to identify effects of catheter inner diameter and bile viscosity on the bile flow rate under the physiological bile pressure difference across obstructed common bile ducts. The feature of minor hydraulic losses in the catheters was clarified, too. The proposed equivalent friction factor was proportional to Reynolds number in a power of -0.654 in comparison with a power of -1 for the fully developed laminar flow in circular pipes. The bile flow rate through a catheter was proportional to inner diameter, kinematic viscosity, and pressure gradient in the powers of 3.2, -0.5 and 0.74, respectively. The minor hydraulic losses could be significant when Reynolds number was greater than 100.

Pleural dissemination of cholangiocarcinoma caused by percutaneous transhepatic biliary drainage during the management of resectable cholangiocarcinoma

BackgroundOnly 3 case reports have addressed pleural dissemination in association with percutaneous transhepatic biliary drainage. The aim of this study was to investigate recurrence after resection of cholangiocarcinoma after percutaneous transhepatic biliary drainage and to clarify the incidence of and the factors responsible for pleural dissemination. MethodsBetween 2001 and 2015, we reviewed retrospectively all consecutive patients who underwent resection for perihilar or distal cholangiocarcinoma after percutaneous transhepatic biliary drainage for recurrence, including pleural dissemination. ResultsDuring the study period, all consecutive patients underwent resection of cholangiocarcinoma after management with percutaneous transhepatic biliary drainage. Of these, 100 patients (32.1%) underwent left-sided percutaneous transhepatic biliary drainage alone, and 212 (67.9%) underwent right-sided percutaneous transhepatic biliary drainage with or without left-sided percutaneous transhepatic biliary drainage. Pleural dissemination, which developed exclusively on the right side of the thoracic cavity after resection, was found in 12 patients (3.8%); these patients underwent right-sided percutaneous transhepatic biliary drainage; computed tomography demonstrated that the percutaneous transhepatic biliary drainage catheter passed through the thoracic cavity in all 12 patients. The diagnosis of pleural dissemination was made at a median of 381 days (range, 44 to 2,944 days) after operation. Survival was poor, with a median survival time of 516 days. Statistically, right-sided percutaneous transhepatic biliary drainage was identified as a risk factor for pleural dissemination. ConclusionPleural dissemination after right-sided percutaneous transhepatic biliary drainage is likely a procedure-related iatrogenic complication because of the “special route” by which the percutaneous transhepatic biliary drainage catheter must be passed through the right thoracic cavity.

Extraluminal Recanalization of Bile Duct Anastomosis Obstruction after Liver Transplantation

This report describes extraluminal recanalization of bile duct anastomosis obstruction after living donor liver transplantation. The procedure was performed in 5 patients in whom negotiation of the biliary anastomotic obstruction by retrograde endoscopic approach and percutaneous intraluminal recanalization had failed. Extraluminal puncture from the donor bile duct to the recipient side bile duct was made with the stiff back end of a 0.035-inch hydrophilic guide wire. After recanalization, a percutaneous transhepatic biliary drainage catheter was placed through the created tract. In all 5 patients, extraluminal recanalization was achieved without major complication, and endoscopic plastic stents were subsequently placed along the tract.

Isolated implant metastasis in chest wall due to seeding of transpleurally placed PTBD catheter tract in a case of hilar cholangiocarcinoma

Percutaneous transhepatic biliary drainage (PTBD) catheter site metastasis in cases of cholangiocarcinoma is reported sporadically. But it is unusual to see left-sided tumour metastasising to the right PTBD catheter site....

Abstract No. 120 - Cost effectiveness of percutaneous transhepatic biliary drainage catheters in malignant biliary obstruction: a financial analysis

Abstract No. 120 - Cost effectiveness of percutaneous transhepatic biliary drainage catheters in malignant biliary obstruction: a financial analysis

Intraductal Papillary Neoplasm of the Bile Duct With Invasive Adenocarcinoma Complicating IgG4-related Sclerosing Cholangitis: Report of a Case

Although there have been many previous studies of IgG4-related SC focusing on the differential diagnosis from cholangiocarcinoma, only a few patients with cholangiocarcinoma against a background of IgG4-related SC have been reported. We herein present a case of intraductal papillary neoplasm of the bile duct (IPNB) associated with invasive carcinoma complicating IgG4-related sclerosing cholangitis. A 71-year-old female with icterus was admitted to a local hospital, where stricture of the extrahepatic bile duct were detected, and subsequently referred to our hospital for possible surgery. Abdominal multidetector-row computed tomography demonstrated marked wall thickening along the entire extrahepatic bile duct. The left lateral superior bile duct (B2) and left lateral inferior duct (B3) were individually obstructed, and percutaneous transhepatic biliary drainage catheters were placed in B2 and B3 separately. The patient was diagnosed to have diffusely spread cholangiocarcinoma and underwent right hepatic trisectionectomy with caudate lobectomy and pancreatoduodenectomy. A histological examination revealed intraductal papillary tumors composed of fibrovascular stalks covered by neoplastic epithelium. Carcinomatous invasion of the papillary tumors was observed in the fibromuscular layer, and there was abundant infiltration of inflammatory cells with fibrosis outside of the cancerous tissue. The inflammatory cells were primarily composed of plasma cells, a majority of which were positive for IgG4 (>30 cells/high-power field); the postoperative serum IgG4 level was 890 mg/dL. Therefore, a diagnosis of coexisting IPNB associated with invasive carcinoma and IgG4-related sclerosing cholangitis was made. To the best of our knowledge, this is the first report of IPNB complicating IgG4-related sclerosing cholangitis.

A National Survey on Peri-interventional Management of Percutaneous Transhepatic Biliary Drainage.

The purpose of this study is to evaluate knowledge about management of percutaneous transhepatic biliary drainage (PTBD) catheters among nurses taking care of hepato-pancreato-biliary (HPB) patients. Six HPB nurses from the Dutch national HPB association created a questionnaire that was complemented by 2 HPB surgeons, 3 HPB interventional radiologists, and a methodologist. Registered nurses working at the department of gastroenterology or gastrointestinal surgery and familiar with the care for HPB patients were invited to complete the questionnaire. In total 120 completed questionnaires from Dutch nurses were returned. The responders were working in 38 of 64 different hospitals. About half of the respondents considered their own knowledge insufficient, which was reflected in the response to the specific questions concerning the PTBD procedure, and 70% rated the knowledge of their immediate nursing colleagues as insufficient. Less than 50% of the respondents knew whether antibiotic-prophylaxis or "pain medication" was required before PTBD procedure. Only a few respondents were aware of the existence of a hospital protocol for PTBD management and its content. Nursing care for biliary catheters is not standardized nationwide, and consensus on management is lacking. An evidence-based guideline for PTBD management is advised for nursing care of patients with HPB diseases.

Peritonitis Caused by Internal Migration of the Percutaneous Transhepatic Biliary Drainage Catheter

ê²½í”¼ê²½ê°„ë‹´ì¦™ë°°ì•¡ìˆ ì€ 담석, 양성협착, ì• ì„±ì¢ ì–‘ 등에 의한 폐쇄성 황달을 감압시키기 위한 ë°©ì‚¬ì„ í•™ì  방법이다. 담관을 통한 담즙의 내부배액이 회복되면 경피경간담즙배액도관은 ê²½í”¼ì ìœ¼ë¡œ ì œê±°í• ìˆ˜ 있다. 본례에서는 병상에서 경피경간담즙배액 도관을 ì œê±°í• ë•Œ, 도관이 복강으로 이동하여 복막염이 ë°œìƒí•˜ì˜€ê³ ê²½êµ¬ë‚´ì‹œê²½ìœ¼ë¡œ 도관을 ì œê±°í•˜ì˜€ë‹¤. 경피경간담즙배액 도관을 ì œê±°í• ë•ŒëŠ” 도관이 복강으로 이동하지 않도록 주의하여야 하며, 부주의로 인하여 도관이 복강으로 이동하였을 경우에는 경구내시경으로 도관을 ì œê±°í• í›„ 있다. Keywords: 도관, ë‹´ì¦™ì •ì²´, 배액, 복막염, 내시경

Ampullary carcinoma associated with removing fractured percutaneous transhepatic biliary drainage catheter for hilar cholangiocarcinoma

Ampullary carcinoma associated with removing fractured percutaneous transhepatic biliary drainage catheter for hilar cholangiocarcinoma

Ampullary Carcinoma Associated With Removing Fractured Percutaneous Transhepatic Biliary Drainage Catheter for Hilar Cholangiocarcinoma

Percutaneous transhepatic biliary drainage (PTBD) is an established method for decompression of biliary tract. Many complications related to PTBD have already been reported, however, spontaneous and complete fracture of PTBD catheter just after procedure is considered to be quite rare. We encountered a case, which PTBD catheter completely fractured on the next day of insertion for biliary obstuction due to hilar cholangiocarcinoma and advanced ampullary carcinoma was appeared at only ten months after removal of the fractured PTBD catheter. A 73-year-old man was diagnosed as hilar cholangiocarcinoma and PTBD was performed. PTBD catheter completely fractured on the next day of insertion. When the fractured PTBD catheter was endoscopically removed though papilla of Vater, there was no abnormality in both papilla of Vater and lower bile duct. Endoscopic biliary drainage was simultaneously performed. Consequently, he underwent extended right hepatectomy with resection of extrahepatic bile duct for Bismuth type IV hilar cholangiocarcinoma. Pathological examination of the resected specimen demonstrated that the tumor mainly composed of moderately differentiated adenocarcinoma and directly invaded to the hepatic parenchyma of the right lobe of the liver; therefore, the tumor was finally diagnosed to be stage IIA (pT3pN0M0) according to TNM classification. The distal stump of bile duct, which was transected at upper border of the pancreas, was pathologically confirmed to be free of cancer. At eight months after surgery, ampullary cacinoma was presented in the follow-up examination.Subtotal stomach-preserving pancreaticoduodenectomy was performed. Because pathological investigation revealed that the tumor was 4-cm in diameter and involved to both pancreas and duodenum, it was diagnosed as stage IIB (pT3pN1M0) according to TNM classification. The postoperative course was uneventful, however, he died of recurrence of ampullary carcinoma at fifteen months after the second operation in another hospital and an autopsy was not performed. We experienced a rare complication that was spontaneous and complete fracture of PTBD catheter on the next day of insertion. When the fractured PTBD catheter was removed by endoscopically, there were no abnormal findings in papilla of Vater and lower bile duct. Therefore, it was presumed that ampullary carcinoma was strongly associated with the removal of the fractured catheter through papilla of Vater. Endoscopic biliary drainage is recommended for decompression of malignant biliary obstruction.

The effects of different preoperative biliary drainage methods on complications following pancreaticoduodenectomy.

The objective of this study was to investigate the effects of different preoperative biliary drainage (PBD) methods on complications in jaundiced patients following pancreaticoduodenectomy. We retrospectively analyzed 270 extrahepatic bile duct cancer patients who underwent pancreaticoduodenectomy. A total of 170 patients without PBD treatment were defined as the non-PBD group. According to different PBD methods, 45, 18, and 37 patients were classified into the percutaneous transhepatic biliary drainage (PTBD), endoscopic nasobiliary drainage (ENBD), and endoscopic retrograde biliary stent (ERBS) groups, respectively. Clinical characteristics and complications were compared among the 4 groups.Preoperative cholangitis occurred in 14 (8.2%) and 8 (21.6%) patients in the non-PBD and ERBS group, respectively (P = 0.04). Compared with the non-PBD group, delayed gastric emptying (DGE) and wound infection occurred significantly more often in the ERBS group. The incidence of severe complications was significantly lower in the PTBD group than the non-PBD group (P = 0.03). Postoperative hospital stay and complication rates were significantly higher in the ERBS group than the PTBD group. There were no significant differences in complications between ENBD and other groups.In conclusion, PTBD can improve surgical outcomes by reducing severe complication rate in jaundiced patients following pancreaticoduodenectomy. ERBS increased the rates of DGE and wound infection due to high incidence of cholangitis before operative intervention and should be avoided. ENBD carried no special effect on complications and needs further analysis.