Percutaneous Transhepatic Biliary Drainage Research Articles

Late onset of biliopleural fistula following percutaneous transhepatic biliary drainage: a case report

Late onset of biliopleural fistula following percutaneous transhepatic biliary drainage: a case report

Ideal outcome post-pancreatoduodenectomy: a comprehensive healthcare system analysis.

Indicators, such as mortality and complications, are commonly used to measure the quality of care. However, a more comprehensive assessment of surgical quality is captured using composite outcome measures such as Textbook Outcome (TO), Optimal Pancreatic Surgery, and a newer 'Ideal Outcome' (IO) measure. We reviewed our institutional experience to assess the impact of demographics, comorbidities, and operative variables on IO after pancreatoduodenectomy (PD). A retrospective study was conducted on PD patients at Northwell Health between 2009 and 2023. IO was determined by the absence of six adverse outcomes, including in-hospital mortality, Clavien-Dindo ≥ III complications, clinically-relevant postoperative pancreatic fistula, reoperation, hospital stay > 75th percentile, and readmission within 30 days. Logistic regression analyzed the effects of various factors on achieving IO. Of the 578 patients who underwent PD, 248 (42.91%) achieved the IO. On multivariable analysis, factors associated with increased odds of achieving IO included neoadjuvant chemotherapy (OR 1.30, 95% CI 1.05-1.62) and the presence of neuroendocrine tumors (OR 3.37, 95% CI 1.35-8.41). Percutaneous transhepatic biliary drainage (PTBD) (OR 0.34, 95% CI 0.14-0.80) and older age (≥ 70 years) (OR 0.48, 95% CI 0.32-0.74) were associated with decreased odds of achieving IO. Patients with IO had significantly improved survival on Kaplan-Meier log-rank test (p = 0.001) as well as adjusted Cox analysis (HR 0.62 95% CI: 0.39-0.97). IO may offer a comprehensive metric for assessing PD outcomes, highlighting the impact of age, chemotherapy, biliary drainage, and tumor types. These findings suggest targeted interventions and quality improvements could enhance PD outcomes by addressing modifiable factors and refining clinical strategies.

Clinical Results of Percutaneous Transhepatic Biliary Drainage With Different Hepatic Access and Methods in the Treatment of Obstructive Jaundice.

Percutaneous transhepatic biliary drainage (PTBD) is a common procedure for biliary obstruction jaundice caused by biliary tract obstruction. PTBD can be performed using external or external-internal methods, by the right or left lobe approach. However, differences in both the method used and the hepatic approach may affect success rates and complications. Therefore, this study aimed to examine the outcomes and complications of PTBD and compare them according to different methods and hepatic approaches. Patients who underwent PTBD procedures in our interventional radiology department due to benign or malignant pathologies between March 2021 and March 2024 were included in the study. The diagnoses of the patients, and total and direct bilirubin values before and after the procedure were recorded. The clinical results and the complications of PTBD were compared statistically according to the hepatic approach and method. Univariate logistic regression analysis was performed to determine significant factors associated with PTBD success and complications. Sixty patients were included in our study (32 men, 28 women; mean age: 67.14±13.61y). The most common indication was malignant bile duct obstruction (90%). The obstruction was mostly at the level of the common bile duct (46.7%). The success rate of PTBD was the highest with the left-side external biliary drainage approach (left-side external biliary drainage, 81.2%; right-side internal-external biliary drainage, 77.8%; right-side external biliary drainage, 69.2%; P=0.596). The complication rate was higher for right-side access (right side 15.9%, left side 12.5%, P=0.744). Univariate logistic regression analysis revealed that PTBD success in females was 5 times higher than in males [Exp(B): 5.000, β: 1.609, P<0.05]. Univariate logistic regression analysis revealed that methods used, entry lobes, and entry levels did not significantly affect PTBD success and complication incidence (P>0.05). All approaches and methods used during PTBD were associated with low complications and high success rates. Nevertheless, external biliary drainage with right hepatic access has the lowest clinical success rate and a higher complication rate than the left-lobe approach. We observed that left-sided external biliary drainage was the most successful method and had fewer complications.

Percutaneous transhepatic biliary drainage in patients with cholestasis following liver transplantation.

Biliary strictures are among the most common complications following liver transplantation (LT). If endoscopic retrograde cholangiography fails, percutaneous transhepatic biliary drainage (PTBD) may serve as an alternative approach. Description of clinical important short- and long-term outcomes as well as outcome prediction following PTBD after LT are scarce. We analyzed outcomes of 56 liver-transplanted adults with biliary complications receiving a PTBD. We described the safety and longitudinal laboratory changes. We analyzed as endpoints, incidence of biliary complications, need for surgical biliary revision/re-LT and overall-survival at 12- and 60-months. We used simple comparison tests accordingly and performed competing risk analysis and multivariate competing risk regression as well as log-rank test and cox proportional hazard regression for further analysis. PTBD procedures had a high technical success rate (98%) and tolerable safety profile. Multiple laboratory indicators improved during follow-up (37 patients with complete biochemical follow-up). Incidence of subsequent biliary complications was highly dependent on the nature of present biliary strictures (Anastomotic stricture (AS): adjusted SHR: 0.26, 95% CI: 0.09-0.78, p = 0.016). Need for surgical biliary revision/re-LT remained below 15%. 12-month survival was significantly better, if drainage into the small intestine was achieved at first attempt compared to completely external drainage (internal: 92.9 vs. external: 67.9%, p = 0.018). Patients with AS had a numerically higher long-term-survival and higher C-reactive-protein (CRP) and lower body-mass-index (BMI) at baseline were significantly associated with inferior short- and long-term-survival. PTBD for biliary complications following LT had a high technical success and a tolerable safety profile. Incidence of subsequent biliary complications was highly dependent on the nature of biliary strictures and increased mortality was found in patients with higher CRP, lower BMI and failure of initial PTBD internalization.

Role of percutaneous transhepatic biliary drainage for managing bile lake formation after Kasai portoenterostomy.

Bile lake (BL) formation following Kasai portoenterostomy (KPE) can complicate the prognosis of biliary atresia (BA). Percutaneous transhepatic biliary drainage (PTBD) performed under fluoroscopic/ultrasonographic (US) guidance is discussed for the management of BL. A retrospective review of 64 BA patients treated by KPE (open = 31, laparoscopic = 33) at a single center (2004-2023) identified 9 BL cases (9/64; 14.1%). PTBD was indicated for jaundice or cholangitis refractory to antibiotic therapy. All BL were asymptomatic, diagnosed after an episode of postoperative cholangitis. KPE type was not correlated with BL incidence; 2/31 (6.5%) for open and 7/33 (21.2%) for laparoscopic; p = 0.15. Median onset was postoperative day 273 (IQR: 170-920). One case resolved with antibiotics while another case required early liver transplantation (LTx) due to advanced hepatic dysfunction unrelated to BL. All remaining cases (7/9) had PTBD at a median of 14.3months (IQR: 7.3-34.7) post-KPE, with successful resolution in 6/7; one case required two PTBD procedures. Post-PTBD biliary peritonitis (n = 3) was resolved by abdominal lavage (laparoscopic = 2; open = 1). Screening for BL is advisable in all postoperative BA patients especially when cholangitis occurs. Although the risk for biliary peritonitis warrants caution, PTBD seems a viable option for managing BL formation after KPE.

Transhepatic Cholangiography and Biliary Drainage: Basic Concepts and Technique

AbstractPercutaneous transhepatic biliary procedures are essential for managing a variety of hepatobiliary conditions, particularly when endoscopic retrograde cholangiopancreatography is not feasible or has failed, or when patients are unstable. This review article provides a comprehensive overview of the indications, contraindications, and procedural steps for biliary puncture, focusing on techniques such as percutaneous transhepatic biliary drainage (PTBD) and percutaneous cholecystostomy. We also address strategies for accessing minimally dilated biliary systems and performing bedside PTBD. The article highlights the increasing demand for these interventions due to rising incidences of biliary diseases such as gallbladder cancer and cholangiocarcinoma, as well as complications arising from previous surgeries. Furthermore, we discuss common and life-threatening complications associated with these procedures, including biliary leaks, hemorrhage, and sepsis, and provide guidance on effective management strategies. Understanding these procedures and their potential complications is crucial for optimizing patient care and outcomes in complex biliary conditions.

Harnessing magnetic forces: Discovery and development of biliary strictures treatment with compression anastomosis

Magnetic compression anastomosis (MCA) is emerging as a promising alternative that uses magnetic force to create an anastomosis bypassing the stenosis in biliary strictures (BSs) where techniques such as percutaneous transhepatic biliary drainage and endoscopic retrograde cholangiopancreatography with stent placement are inadequate in the presence of complete obstruction or severe stenosis. MCA offers potential benefits such as less operative trauma, shorter hospital stay and lower complication rates. By placing magnets proximal and distal to the stenosis, necrosis of fibrotic tissue occurs, creating a new anastomosis. Investigating the role of MCA in the treatment of BS is crucial because of its potential to revolutionize care, improve outcomes and reduce healthcare costs. It offers an alternative for patients who are not suitable for conventional surgery. A comprehensive review of the principles, techniques, outcomes and applications of MCA is essential to inform clinicians, researchers and policy makers and to guide future research and clinical practice to optimize patient care for BSs.

Assessment of occupational dose during abdominal fluoroscopic-guided procedures in Thailand using nanoDot OSL dosimeters

Interventional radiology is one of the most widely used treatment options for abdominal abnormality. Due to new dose limitations, radiation is a hazard that needs to be considered when choosing the international treatment technique. The aim of this study was to measure the effective/equivalent doses and to investigate the associated factors correlating with the doses during Transarterial Chemoembolization (TACE) and Percutaneous Transhepatic Biliary Drainage (PTBD) for radiologists, technologists and nurses involved with the treatment. This prospective study reports occupational dose per procedure of 57 cases (TACE = 42, PTBD = 15) in a Thailand hospital spanning one year. All staff included in this study wore 30 nanoDot Optically Stimulated Luminescence Dosimeter for measuring doses at 7 bodily locations. The average dose area product and cumulative doses was 151.3 Gy·cm2, 1,185.1 mGy during TACE and 21.3 Gy·cm2, 212.2 mGy during PTBD. The radiation exposure of the radiologists was significantly higher than technologists and nurses (p-value < 0.05). The lead protection equipment was a dose-reducing factor which decreased the dose up to 93%. The present study also contributes to the establishment of an individual dose location report and identifies significant correlations between associated factors and dose values. The left hand (1.2 mSv) and the left eye (1.1 mSv) showed maximum doses during the PTBD procedure. The exceeded dose over the limitation was observed in the left eye. We concluded that the dose feedback was able to increase awareness of the occupation staff. So, dose monitoring, updating education and regular training could be applied simply and effectively to improve skills, while reducing the occupational dose.

Management of biliary complications after LDLT.

Biliary complications (BC) in the recipient continue to be an as yet, unresolved issue following living donor liver transplantation (LDLT). Bile leaks (BL) and biliary anastomotic strictures (BAS) are the most common BCs, with the latter contributing to close to 80%. With increasing expertise, endoscopic treatment with endoscopic retrograde cholangiography (ERC) [the first-line treatment] and percutaneous transhepatic cholangiography (PTC) with percutaneous transhepatic biliary drainage (PTBD) alone or in combination with ERC lead to successful management in a majority of these cases. However, prediction of difficulty of endoscopic success in biliary strictures, optimal duration of indwelling stents and their planned removal, management options in high-grade strictures (HGS) and the long-term outcome of patients requiring intervention for BC's are still unanswered questions in this setting. This review will try to summarise pertinent issues, novel insights and finally propose basic principles to be adhered to when dealing with the gamut of possible biliary complications after LDLT.

Comparative Analysis of ERCP and PTBD for Biliary Interventions for Readmission Rates and Patient Outcomes.

Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) are interventions used to relieve biliary obstruction. The utility of ERCP compared with PTBD is not fully understood from a utilization outcome standpoint. Our study compares readmission rates and hospitalization outcomes in ERCP and PTBD. Using the National Readmission Database (NRD) 2016 to 2020, we identified all patients with an ERCP or PTBD completed during admission. The study cohort was first analyzed by 3 weighted study arms including those admitted with cholangitis, biliary/pancreatic malignancy, and choledocholithiasis. Second, we analyzed the cohort by a 1:1, unweighted propensity match. The primary outcome was 30 day, 90 day, and 6 month readmission. Secondary outcomes were readmission/overall mortality, cost, and length of stay. Outcomes were analyzed using multivariate analysis. A total of 621,735 admissions were identified associated with 589,796 ERCP and 31,939 PTBD. In the propensity matched cohort, PTBD had a higher readmission rate at 30 days (20.38% vs. 13.71% P<0.0001), 90 days (14.63% vs. 13.14%, P<0.0001) but lower rate at 6 months (8.50% vs. 9.67%, P=0.0003). Secondary outcomes included increased PTBD-associated hospital length of stay (9.01d vs. 6.74d, P<0.0001), hospitalization cost ($106,947.97 vs. $97,602.25, P<0.0001), and overall mortality (6.86% vs. 4.35%, P<0.0001). No major differences were found for mortality among readmissions at 30 days (7.19% vs. 6.88%, P=0.5382), 90 day (6.82% vs. 6.51%, P=0.5612), and 6 months (5.08% vs. 5.91%, P=0.1744). ERCP demonstrated superior results compared with PTBD for readmission rates, length of stay and overall mortality. For failed ERCP cases, emerging data for Endoscopic ultrasound guided-biliary drainage (EUS-BD) offers potential over PTBD and may provide additional options for the future in tertiary referral centers with experience.

1482P Percutaneous transhepatic biliary drainage (PTBD) for palliation of jaundice in patients of unresectable/disseminated carcinoma gall bladder with hilar block: Is it a worthwhile enterprise?

1482P Percutaneous transhepatic biliary drainage (PTBD) for palliation of jaundice in patients of unresectable/disseminated carcinoma gall bladder with hilar block: Is it a worthwhile enterprise?

Role of Percutaneous Transhepatic Biliary Drainage in Management of Obstructive Jaundice

Role of Percutaneous Transhepatic Biliary Drainage in Management of Obstructive Jaundice

The Risk Factors of Early Biliary Infection After 125I Particles Stent Implantation in Patients with Malignant Biliary Obstruction

Background: Early biliary infection (EBI) is a significant and prevalent complication following percutaneous transhepatic biliary stenting, especially in cases involving the use of 125I particle stents for malignant biliary obstruction (MBO). Objectives: This study aims to uncover potential risk factors contributing to EBI post-implantation in this patient group. Patients and Methods: In this retrospective study, a total of 231 patients who underwent 125I particle stent implantation between January 2014 and December 2020 were included. Screening based on inclusion/exclusion criteria identified a total of 178 patients (115 males and 63 females, aged 32 - 83 years). Early biliary infection occurrence was monitored within the first 30 days following the stent implantation, when infectious complications are most prevalent. We analyzed baseline characteristics and perioperative parameters of patients, comparing those who developed EBI with those who did not. Multivariate logistic regression was employed to identify significant risk factors for EBI. Results: Out of the 178 patients, 35 (19.7%) developed EBI within 30 days post-implantation. Every EBI case was accompanied by a positive bile culture. Notably, patients with EBI more frequently had diabetes [odds ratio (OR), 3.329; 95% confidence interval (CI), 1.129 - 9.819; regression coefficient (B) = 1.203; P = 0.029], gallstones in the gallbladder or bile ducts (OR, 3.459; 95% CI, 1.060 - 11.283; B = 1.241; P = 0.040), higher level of biliary obstruction (OR, 3.008; 95% CI, 1.243 - 7.280; B = 1.101; P = 0.015), intraoperative biliary bleeding (OR, 5.416; 95% CI, 1.569 - 18.696; B = 1.689; P = 0.008), and postoperative intrahepatic pneumobilia (OR, 2.655; 95% CI, 1.108 - 6.362; B = 0.976; P = 0.029) compared to those without EBI. These factors were positively correlated with EBI development post-implantation. Conversely, the duration from percutaneous transhepatic biliary drainage (PTBD) to 125I stent implantation was longer in patients without EBI (OR, 0.966; 95% CI, 0.940 - 0.992; B = - 0.035; P = 0.012), suggesting a negative association with EBI occurrence. Conclusion: This study identifies diabetes, gallstones in the gallbladder or bile ducts, high-level obstruction, intraoperative biliary bleeding, and postoperative intrahepatic pneumobilia as significant risk factors for EBI. Additionally, a longer interval from PTBD to 125I stent implantation emerges as a protective factor against EBI in patients with MBO undergoing 125I particle stent implantation. These risk factors can offer guidance to minimize post-125I particle stent implantation biliary infection, thereby shortening hospitalization for affected patients.

Comparative Efficacy of Magnetic Resonance Cholangiopancreatography vs. Percutaneous Transhepatic Cholangiography With Percutaneous Transhepatic Biliary Drainage Stenting in Evaluating Obstructive Jaundice: A Prospective Study in South India.

Introduction Obstructive jaundice due to proximal biliary obstruction presents significant diagnostic and therapeutic challenges. Accurate and timely diagnosis is essential for effective management. Objective/aim This study aimed to evaluate and compare the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) and percutaneous transhepatic cholangiography (PTC) along with percutaneous transhepatic biliary drainage (PTBD) stenting in obstructive jaundice, while also incorporating the comparison of ultrasonography (USG) and computed tomography (CT) findings. Materials and methods A prospective study was conducted at a tertiary healthcare center in South India from January 2020 to June 2022. Comprehensive diagnostic evaluations were performed using USG, contrast-enhanced computed tomography (CECT), MRCP, and PTC. The diagnostic outcomes from USG and CECT were initially assessed, followed by MRCP for every patient. These results were then compared with PTC, focusing on identifying the causes and levels of biliary obstruction. Results Fifty patients with suspected obstructive jaundice were included in the study. The study predominantly involved patients aged between the fourth and eighth decades (80%). Choledocholithiasis was identified as the leading cause (30%). MRCP demonstrated superior sensitivity in identifying both the cause (80%) and level (88%) of obstruction. It was particularly effective in detecting hilar masses with 100% sensitivity. Conversely, PTC, while less sensitive in detection, offered the advantage of simultaneous therapeutic intervention through stenting, with a sensitivity rate of 93% in detecting hilar masses. Conclusion MRCP outperforms PTC in diagnostic sensitivity for obstructive jaundice caused by proximal biliary obstruction. However, the advantage of PTC lies in its capacity for immediate therapeutic intervention via stent placement, addressing both diagnostic and treatment needs.

Bile duct diffusion-weighted image hyperintensity predicts intrahepatic biliary complications after ABO-incompatible liver transplantation.

We assessed the value of the diffusion-weighted image (DWI) for predicting intrahepatic biliary complications (IHBC) after ABO-incompatible liver transplantation (ABOi-LT), potentially leading to refractory cholangitis. In this retrospective study at a single center, 56 patients who underwent ABOi-LT from March 2021 to January 2023 were analyzed. All received magnetic resonance cholangiopancreatography (MRCP) and DWI during the postoperative hospitalization. MRCP findings, including bile duct DWI hyperintensity, were assessed. Participants suspected of having a biliary infection or obstructive jaundice underwent endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage (PTBD) during the follow-up. Non-anastomotic biliary strictures on cholangiography were classified as IHBC, as either perihilar or diffuse form. DWI hyperintensity was compared between groups with and without IHBC. Logistic regression analysis was performed to identify independent risk factors for IHBC. Of the 55 participants (median age 55 years, 39 males), IHBC was diagnosed in eight patients over a median follow-up of 15.9 months (range 5.6-31.1). Bile duct DWI hyperintensity was observed in 18 patients. Those with DWI hyperintensity exhibited a higher IHBC incidence (6/18, 33.3% vs. 2/36, 5.6%; p = 0.01), and more frequently developed the diffuse type IHBC (4/18, 22.2% vs. 1/36, 2.8%; p = 0.04). Regression analysis indicated that bile duct DWI hyperintensity is an independent risk factor for IHBC (odds ratio (OR) 10.1; 95% confidence interval (CI) 1.4, 71.2; p = 0.02) and its diffuse form (OR 15.3; 95% CI 1.2, 187.8; p = 0.03). Postoperative DWI hyperintensity of bile ducts can serve as a biomarker predicting IHBC after ABOi-LT. Postoperative diffusion-weighted image hyperintensity of the bile duct can be used as a biomarker to predict intrahepatic biliary complications and aid in identifying candidates who may benefit from additional management for antibody-mediated rejection. Intrahepatic biliary complications following ABO-incompatible liver transplantation can cause biliary stricture and biloma formation. Bile duct hyperintensity on early postoperative diffusion-weighted imaging was associated with increased intrahepatic biliary complication risk. This marker is an additional method for identifying individuals who require intensive management to prevent complications.

Efficacy and safety analysis of continued nursing of complications in discharged patients after percutaneous transhepatic biliary drainage.

Percutaneous hepatobiliary drainage (PTCD) is an effective method for the treatment of biliary obstruction and other diseases, but postoperative complications are still one of the important problems faced by patients. Continuous nursing is a comprehensive nursing model that plays an important role in postoperative recovery. The purpose of this study was to investigate the effect of continuous nursing on the incidence of complications in patients after PTCD surgery through meta-analysis and to evaluate its efficacy and safety. To evaluate the effect of extended nursing on the incidence of complications in discharged patients after percutaneous transhepatic biliary drainage (PTBD). Randomized controlled studies on PTBD postdischarge extended care were identified in the CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, Embase, Web of Science, and other databases. The quality of the included studies was evaluated using the Joanna Briggs Institute of Australia literature quality evaluation tool, and a meta-analysis of the included studies was performed with RevMan 5.4 software. Finally, 9 studies were included, with a total sample size of 854 patients (425 patients in the control group and 429 patients in the intervention group). Meta-analysis revealed that extended care effectively reduced biliary tract infection (RR: 0.42, 95%CI: 0.30-0.57), puncture wound infection (RR: 0.19, 95%CI: 0.06-0.65), catheter protrusion or displacement in discharged patients after PTBD (RR: 0.31, 95%CI: 0.18-0.54), catheter blockage (RR: 0.23, 95%CI: 0.13-0.42), skin infection around the drainage tube (RR: 0.30, 95%CI: 0.12-0.77), and catheter-related readmissions (RR: 0.34, 95%CI: 0.18-0.65) (P < 0.05). Compared with conventional discharge care, extended care can effectively reduce the occurrence of complications such as biliary tract infection, puncture wound infection, catheter prolapse or displacement, catheter blockage, skin infection around the drainage tube, and catheter-related readmission in discharged patients after PTBD.

Endoscopic ultrasound-guided biliary drainage in failed endoscopic retrograde cholangiopancreatography: A case series and review of literature

Abstract Obstructive jaundice is a common clinical manifestation of malignant biliary obstruction (MBO). Pancreaticobiliary malignancy causes a significant proportion of distal biliary obstructions, most of which are unresectable at the time of diagnosis. Palliative biliary drainage is required in cases of unresectable malignant distal biliary obstruction (MDBO). Surgical, endoscopic, or percutaneous methods can relieve biliary obstruction. Percutaneous transhepatic biliary drainage (PTBD) is the most common alternative method if endoscopic retrograde cholangiopancreatography (ERCP) fails. The complication rate of PTBD and associated comorbidities is high. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has two access routes, i.e., intrahepatic and extrahepatic. The technical and clinical success rate of EUS-BD is high, exceeding 90%. When ERCP fails, the EUS rendezvous approach should be attempted first if papilla is accessible. Transmural drainage is the preferred method if the papilla is inaccessible. For distal and mid-common bile duct obstruction, we perform EUS-guided choledochoduodenostomy (EUS-CDS). For EUS-CDS, one can use either a self-expandable metallic stent (SEMS) or a lumen-apposing metal stent. EUS-BD procedures are technically challenging, and adverse events are common even in expert hands. A multidisciplinary approach is most appropriate for patients with distal MBO who fail ERCP.

Improved Survival With Chemotherapy in Patients With Malignant Biliary Tract Obstruction After Percutaneous Transhepatic Biliary Drainage (PTBD).

Introduction Biliary tree stenting for malignant biliary tract obstructions is a routine modality for the relief of jaundice. Treatment is palliative in most circumstances. However, adequate reduction in bilirubin levels after percutaneous transhepatic biliary drainage (PTBD) may help to offer chemotherapy, which may improve survival in a limited number of cases. Materials and methods Between March 2017 and March 2023, patients who were treated with PTBD to relieve malignant biliary tract obstruction were included in the analysis. Patients who achieved bilirubin levels ≤5 mg/dLafter PTBD were considered for chemotherapy. For survival analysis, a comparison was done between patients treated with chemotherapy after PTBD versus patients who did not receive any treatment after PTBD. Results Data was available for 43 (100%) patients. After PTBD, 16 (37.2%) patients responded and were considered for further treatment. One patient who was advised of radical surgery refused treatment and did not return for further treatment or follow-up. The remaining 15 cases (34.9%) received Gemcitabine and platinum-based chemotherapy as a first-line option. Out of 15 cases who received chemotherapy only one patient (6.6%) received neoadjuvant chemotherapy and the rest of14 (32.5.%) cases received palliative chemotherapy in view of metastatic disease. PTBD complications including leakage, dislodgement of PTBD catheter, pain, and bleeding were seen in 16 (37.2%) cases. Overall survival was 57% for the entire population. Patients treated with chemotherapy after PTBD had better overall survival compared to patients who did not receive any treatment after PTBD (73.3% vs 33% (p=0.008)). Conclusion PTBD is an excellent technique for the relief of biliary obstruction. More than one-third (34.9%) of the cases received further cancer-directed treatment after relief of jaundice by PTBD. Chemotherapy after PTBD is associated with improvement in overall survival in malignant biliary obstructions.

Impact of biliary drainage method before pancreaticoduodenectomy on short- and long-term outcomes in patients with periampullary carcinoma and obstructive jaundice: A multicenter retrospective analysis

BackgroundThe optima preoperative biliary drainage before pancreaticoduodenectomy in patients with biliary tract and pancreatic cancer remains controversial. MethodsA total of 898 patients who underwent preoperative biliary drainage via endoscopic retrograde biliary drainage, endoscopic transnasal biliary drainage, or percutaneous transhepatic biliary drainage before pancreaticoduodenectomy for biliary tract and pancreatic cancer were included. Perioperative and long-term outcomes were analyzed. ResultsThe Clavien-Dindo grade ≥3 morbidity rates after pancreaticoduodenectomy were higher in the endoscopic retrograde biliary drainage (21.9%; P = .001) or endoscopic transnasal biliary drainage (20.2%; P = .007) than in the percutaneous transhepatic biliary drainage (9.7%) groups. In biliary tract cancer, the frequency of dissemination after pancreaticoduodenectomy was higher in the percutaneous transhepatic biliary drainage (15.3%) than in the endoscopic retrograde biliary drainage (0.7%; P = .001) and endoscopic transnasal biliary drainage (4.1%; P = .037) groups; percutaneous transhepatic biliary drainage was an independent factor associated with worse disease-free survival (P = .04), whereas in pancreatic cancer the frequency of dissemination and survival was comparable among the 3 preoperative biliary drainage methods. Albumin <3.9 g/dL was independently associated with worse overall survival in patients with both pancreatic (P = .038) and biliary tract (P = .002) cancers, respectively. During biliary drainage, external drainage (P = .038) was independently associated with albumin <3.9 g/dL; albumin was higher in endoscopic retrograde biliary drainage group than in endoscopic transnasal biliary drainage or percutaneous transhepatic biliary drainage groups after 21 days from tube insertion. ConclusionIn biliary tract cancer, percutaneous transhepatic biliary drainage may carry the risk of increasing the incidence of disseminative recurrence. In pancreatic cancer, percutaneous transhepatic biliary drainage is preferable owing to fewer complications without influencing recurrence. However, if patients cannot undergo surgery immediately, endoscopic retrograde biliary drainage will be applicable to help the preservation of nutritional status, which can have an impact on survival.

Improvement in Bilirubin Levels Following Percutaneous Transhepatic Biliary Drainage Using Central Line: A Case Series of 50 Patients

Improvement in Bilirubin Levels Following Percutaneous Transhepatic Biliary Drainage Using Central Line: A Case Series of 50 Patients