Percutaneous Transhepatic Cholangiography And Drainage Research Articles

The Clinical Impact of Different Types of Preoperative Biliary Intervention on Postoperative Biliary Tract Infection of Patients Undergoing Pancreaticoduodenectomy.

Background: For patients with obstructive jaundice and who are indicated for pancreaticoduodenectomy (PD) or biliary intervention, either endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography and drainage (PTCD) may be indicated preoperatively. However, the possibility of procedure-related postoperative biliary tract infection (BTI) should be a concern. We tried to evaluate the impact of ERCP and PTCD on postoperative BTI. Methods: Patients diagnosed from June 2013 to March 2022 with periampullary lesions and with PD indicated were enrolled in this cohort. Patients without intraoperative bile culture and non-neoplastic lesions were excluded. Clinical information, including demographic and laboratory data, pathologic diagnosis, results of microbiologic tests, and relevant infectious outcomes, was extracted from medical records for analysis. Results: One-hundred-and-sixty-four patients from the cohort (164/689) underwent preoperative biliary intervention, either ERCP (n = 125) or PTCD (n = 39). The positive yield of intraoperative biliary culture was significantly higher in patients who underwent ERCP than in PTCD (90.4% vs. 41.0%, p < 0.001). Although there was no significance, a trend of higher postoperative BTI (13.8% vs. 2.7%) and BTI-related septic shock (5 vs. 0, 4.0% vs. 0%) in the ERCP group was noticed. While the risk factors for postoperative BTI have not been confirmed, a trend suggesting a higher incidence of BTI associated with ERCP procedures was observed, with a borderline p-value (p = 0.05, regarding ERCP biopsy). Conclusions: ERCP in patients undergoing PD increases the positive yield of intraoperative biliary culture. PTCD may be the favorable option if preoperative biliary intervention is indicated.

Clinical features and treatment of hepatic abscesses with biloma formation after transcatheter arterial chemoembolization

Background and study aimsA full understanding of the clinical manifestations and risk factors for hepatic abscesses with biloma formation after transcatheter arterial chemoembolization (TACE) is crucial for accurate diagnosis and effective therapeutic intervention. Patients and methods11,524 patients with hepatic tumors were treated with TACE. 84 patients were diagnosed with hepatic abscesses after TACE, and 35 progressed to hepatic bilomas and were treated with percutaneous transhepatic drainage (PTD) and/or percutaneous transhepatic cholangiography and drainage (PTCD). Clinical features, blood samples, bacterial cultures, and imaging data were collected, and incidence, risk factors, therapeutic effects, and prognostic indicators were analyzed. ResultsThe incidence of biloma in patients with liver abscesses was 41.7% with an average diagnosis time of 12.3 ± 3.2 days. 71.4% of patients complained of abdominal pain, and 63.7% had metastatic liver cancer. In the latter patients, clinical features included multiple abscess lesions with a poor blood supply to the tumor and large necrotic lesions. The original tumors were primarily in the digestive system (87.0%). The mean diameter of the largest lesions was 6.5 ± 2.3 cm. Before abscess formation, the Child-Pugh liver function classification was grade A in 14 cases and grade B in 21 cases. Escherichia coli was the most frequently seen infectious bacteria. Liver function was significantly compromised by the occurrence of hepatic abscesses. The mean survival time after diagnosis of liver abscesses in all patients was 11.5 ± 0.6 months. The causes of death included abscess (n = 9, 25.7%), tumor (n = 22, 62.9%), and other causes (n = 4, 11.4%). Risk factors included tumors, gastrointestinal surgery, and diabetes. ConclusionPTD and/or PTCD combined with active antibiotics are recommended as the first-line treatment and are effective therapeutic regimens for biloma formation after TACE.

Intrabiliary Metastasis of Colon Cancer Mimicking Cholangiocarcinoma and Chemotherapy-Induced Sclerosing Cholangitis: A Case Report

Intrabiliary metastasis of colon cancer without the involvement of the hepatic parenchyma is very rare and can cause biliary obstruction. We herein present a rare case of colon cancer metastasis that developed after right hemicolectomy and while undergoing chemotherapy. Computed tomography (CT) of the abdomen and percutaneous transhepatic cholangiography and drainage (PTCD) was performed because of obstructive jaundice. CT-guided biopsy showed high-grade atypical glands that were CK7(−), CK20(+), and CDX-2(+); metastatic adenocarcinoma would be considered first rather than cholangiocarcinoma. Clinicians should be aware that intrabiliary metastasis of colon cancer can mimic cholangiocarcinoma and chemotherapy-induced sclerosing cholangitis.

Percutaneous transhepatic cholangiography and drainage and endoscopic retrograde cholangiopancreatograph for hilar cholangiocarcinoma: which one is preferred?

both percutaneous transhepatic cholangiography and drainage (PTCD) and endoscopic retrograde cholangiopancreatography (ERCP) with SEMS implantation have been used for unresectable hilar cholangiocarcinoma (HC) in the clinic for many years. However, which one is preferred is still unknown. to study the effects of biliary drainage of self-expanding metal stents (SEMS) implantation under PTCD or ERCP to treat HC. the clinical data of 82 patients with HC from January 2006 to January 2015 were recorded retrospectively. Patients were treated with biliary implantation of self-expanding metal stents (SEMS) under PTCD (PTCD group, 40 patients) or ERCP (ERCP group, 42 patients). Clinical data, including total bilirubin concentrations, complications and survival time were analyzed. the remission of jaundice was similar in both groups (p > 0.05). The median survival time of the ERCP group and PTCD group were 237 d and 252 d respectively, with no significant differences (p > 0.05). The biliary infection rates under ERCP and PTCD procedure were 52.4 % and 20.0 % respectively, with a significant statistical difference (p < 0.05). For those HC patients of Bismuth III/IV, the infection rates under ERCP and PTCD procedure were 58.3 % and 14.3 %, respectively (p < 0.05). both PTCD and ERCP with SEMS implantation were effective to prolong the survival time of HC patients. The biliary infection rates were higher in the ERCP group, especially for Bismuth III/IV HC patients.

Endoscopic Retrograde Biliary Drainage Causes Intra-Abdominal Abscess in Pancreaticoduodenectomy Patients: An Important But Neglected Risk Factor.

Patients with periampullary cancer frequently suffer obstructive jaundice and commonly require preoperative biliary drainage (PBD) for relief and to avoid related complications. Although research has established a correlation between PBD and surgical wound infection, the impact of PBD on major infectious complications (intra-abdominal abscess [IAA]) and overall mortality remains debatable. We hypothesized that PBD could lead to IAA and mortality, and evaluated their correlation in patients undergoing pancreaticoduodenectomy (PD). We enrolled patients undergoing PD at an Asian academic medical center between 2007 and 2016. The types of PBD included endoscopic retrograde biliary drainage (ERBD) and percutaneous transhepatic cholangiography and drainage (PTCD). The primary outcome was IAA, defined as the presence of pus or infected fluid inside the abdominal cavity and with documented infectious pathogens. There was one (0.1%) 30-day mortality and eight (0.9%) 90-day mortalities among 899 consecutive patients examined. More than one-quarter of patients had PBD (n = 237, 26.4%; 165 ERBD, 72 PTCD). In the ERBD, PTCD, and non-PBD groups, the IAA rates were 37.0%, 16.7%, and 10.6%, respectively. On multivariate analysis, ERBD (odds ratio 3.67; 95% confidence interval 2.22-6.06; p < 0.001) was the only significant factor associated with IAA. No significant factor was found to analyze variables associated with mortality. ERBD, but not PTCD, is associated with an increased risk of IAA in patients undergoing PD, which suggests that ERBD should be avoided whenever possible to prevent IAA. Further randomized clinical trials should be conducted to validate this relationship.

Hepatic Artery Pseudoaneurysm Masquerading as Malignant Jaundice

Introduction: Visceral artery aneurysms and pseudoaneurysms (PSAs) are rare conditions with a reported incidence of 0.1 to 0.2%. The etiology of most PSAs are abdominal trauma, iatrogenic or pancreatico-biliary procedures. Hepatic artery PSAs are often asymptomatic or can present with abdominal pain, nausea, hemobilia, and rarely jaundice. Case Report: A 74-year-old man presented with jaundice, pruritus, and malaise that progressively worsened over a 2 week period. On admission the total bilirubin (TB) levels was 7.6, direct bilirubin (DB) 4.9, aspartate aminotransferase (AST) 39, alanine aminotransferase (ALT) 35, alkaline phosphatase (ALP) 214, Ca 19-9 79.4, and CEA 1.1. A contrast-enhanced computerized tomography (CT) scan was performed which showed significantly distended intrahepatic bile ducts, a common hepatic duct (CHD) stricture and a 2.6 x 3.8 cm contrast-filled lobulated stricture consistent with a PSA of the right hepatic artery (RHA) (Figure 1). Endoscopic retrograde cholangiopancreatography (ERCP) was attempted, however cannulation was unsuccessful. A percutaneous transhepatic cholangiogram was therefore performed identifying a severe stricture in the common hepatic duct. Bilateral percutaneous transhepatic biliary drains were placed, and brushings of the bile duct were performed. Cytology brushing were unremarkable, and there remained concern for cholangiocarcinoma. Eight days after percutaneous transhepatic cholangiography and drainage (PTCD), the patient presented with bloody drainage in his right hepatic drain. The patient underwent a PTCD which revealed a complex communication between the CHD and the RHA (Figure 2). The PSA was successfully embolized. An ERCP (Figure 2) was then performed with digital cholangioscopy (Figure 3). No tumor was visualized and a CHD stricture was confirmed due to extrinsic compression. The patient was managed conservatively and during outpatient clinic follow-up he was asymptomatic and his liver enzymes had normalized.Figure 1Figure 2Figure 3Discussion: Our case represents a spontaneous hepatic artery psudoaneurysm causing obstructive jaundice. In rare situations PSAs may develop from atherosclerosis. ERCP with digital cholangioscopy was crucial in our case to demonstrate an absence of a tumor and correctly identify extrinsic compression from the PSA.

The use of ultrasound contrast agents for percutaneous transhepatic cholangiography and drainage

Purpose: The aim of the study was to evaluate the usefulness of extravascular contrast enhanced ultrasound (EV-CEUS) in ultrasound (US) guided percutaneous transhepatic cholangiography and drainage (PTCD) and assessing complications.

Management and long-term efficacy of patients with iatrogenic bile duct injury

Objective To investigate the management of iatrogenic bile duct injury and evaluate the longterm efficacy.Methods The clinical data of 62 patients with iatrogenic bile duct injury who were admitted to the Peking Union Hospital from January 1982 to April 2012 were retrospectively analyzed.Of the 62 cases of iatrogenic bile duct injuries,24 were caused by laparoscopic cholecystectomy (LC) and 38 were caused by open cholecystectomy. Ten patients received non-surgical treatment, including 8 patients received percutaneous transhepatic cholangiography and drainage (PTCD) and 2 received endoscopic retrograde cholangiopancreatography (ERCP) + stent implantation. Fifty-two patients received surgical treatment,including 47 received cholecystojejunostomy,2 received cholecystoduodenostomy,3 received biliary end-to-end anastomosis. Thirty-six patients received PTCD preoperatively,and 42 received biliary stent implantation intraoperatively.Fifty patients received intraoperative peritoneal drainage to prevent postoperative peritoneal effusion or encapsulated bile collection.Results Of the 52 patients who received surgery,13 patients were complicated by more than 1 complication,including 1 case of wound infection,4 cases of cholangitis,2 cases of anastomotic leakage,2 cases of anastomotic bleeding,1 case of anastomotic occlusion, 1 case of biliary stent falling out and 3 cases of gastrointestinal diseases.Eighteen patients received cholangiography postoperatively,and 2 patients were diagnosed as with bile leakage.Fifteen patients received PTCD + biliary stent implantation,and 1 patient of them received percutaneous puncture drainage.Two patients received reoperation due to anastomotic bleeding.The mean time of peritoneal drainage for the 50 patients was (7.7 ± 2.6) days.No perioperative death was observed,and the mean operation time was (18 ± 12) days.Fifty-five patients were followed up (10 patients received non-surgical treatment,and 45 patients received surgical treatment),with a median time of 93 months.Of the 10 patients who received nonsurgical treatment,1 received reoperation due to bile leakage,3 received PTCD for the second time due to repeated cholangitis after PTCD. Of the 45 patients who received surgical treatment,6 patients had long-term complications,including 6 cases of fever,4 cases of jaundice,3 cases of choledocho-lithiasis and 1 case of bile duct canceration; 4 received reoperation at the second year after operation.Conclusions Early diagnosis of bile duct injury and operation carried out by experienced surgeons are important for a better short- and long-term prognosis.Surgical repair is the first line therapy for bile duct injury. Key words: Bile duct injury, iatrogenic; Cholecystectomy; Long-term efficacy

Long-term drainage following PTCD for treatment of ischemic-type biliary lesion after liver transplantation

Objective To evaluate the effectiveness, safety and clinical feasibility of long-term drainage following percutaneous transhepatic cholangiography and drainage (PTCD) for the treatment of ischemic-type biliary lesion (ITBL) after liver transplantation. Methods There were 11 patients with ITBL after liver transplantation. Of the 11 patients with a mean age of 42. 3, 10 were male and 1 female. All 11 cases were diagnosed by PTC or ERC (endocopic retiogiade cholangiogiaphy) before PTCD, and they responded poorly to medication or draining and stenting with ERCP. Long-term drainage following PTCD was performed, whereas adjuvant percutaneous aspiration through double guidewire technique was used for the patients with large quantities of chole mud. Results There were three types of ITBL: type Ⅰ (extrahepatic lesions, n=7), type Ⅱ (intrahepatic lesions, n= 1), and type Ⅲ (intra- and extra-hepatic alterations, n=3). PTCD was performed in all 11 patients successfully. The values of total bilirubin (TBIL) and direct reacting bilirubin (DBIL) were 206.70±54.18μmol/L, 170. 65±53. 97μmol/L and 90. 63± 13.00μmol/L, 63. 83± 13.61μmol/L before and 1 week after PTCD, respectively. The follow-up period was from 3 through 71 months (mean 20 months). During the follow-up, TBIL values ranged between 23.70 μmol/L and 241.0 μmol/L (mean 55.3±15.6 μmol/L), and DBIL values were between 8. 1 and 162.0 μmol/L (mean 32. 53±10. 21 μmol/L). Hepatic functions were good in 9 cases including 5 cases in which the drainage tube was withdrawn after long-time drainage (6～ 12 months, mean= 8.2 months) and 4 cases in which drainage continued. The other 2 cases received liver retransplantation for the grafts dyssynthesis of albumen after drainage for 3 and 8 months. Conclusion Long-term drainage following PTCD is an effective and safe approach for ITBL following liver transplantation. Key words: Liver transplantation; Ischemic-type biliary lesion; Percutaneous transhepatic cholangiography and drainage

Percutaneous Transhepatic Cholangiography and Drainage is an Effective Rescue Therapy for Biliary Complications in Liver Transplant Recipients Who Fail Endoscopic Retrograde Cholangiopancreatography

We attempted to evaluate both the factors that predispose a patient to biliary complications after liver transplantation and the results of percutaneous transhepatic cholangiography and drainage (PTCD) for the management of those complications. This study retrospectively reviewed the cases of 81 patients who received liver transplants at Taipei Veterans General Hospital between February 2003 and June 2008. Biliary complications were diagnosed on the basis of clinical findings, laboratory data, and the results of imaging studies. A total of 18 patients (22.2%) developed biliary complications, and living donor liver transplantation (LDLT) was a significant risk factor (p = 0.035), compared to cadaveric liver transplantation. Eight patients with biliary complications received PTCD as the first treatment modality and 6 had successful results. An additional 10 patients received endoscopic retrograde cholangiopancreatography (ERCP) initially, but only 2 patients were effectively managed. One patient received conservative treatment after ERCP failure. One patient died from sepsis after ERCP. The remaining 6 patients with failed ERCP were successfully managed with PTCD. The overall mortality rate in these patients with biliary complications was 16.7%. No significant prognostic predictors were identified, including age, sex, biochemical data, and model for end-stage liver disease scores. Biochemical markers cannot predict biliary complications preoperatively. LDLT increases the risk of biliary complications. PTCD is an effective rescue therapy when ERCP fails.

Long-term outcome of interventional therapy for malignant biliary obstruction: a retrospective analysis of 109 cases

To evaluate the long-term outcome and its relative influenced factors of interventional therapy in dealing malignant biliary obstruction (MBO). 109 MBO patients, 54 males and 55 females, aged (71 +/- 12), underwent interventional therapy: 55 patients received percutaneous transhepatic cholangiography and drainage (PTCD), and 54 underwent bile duct stent implantation. One week later, total bilirubin (TB), direct bilirubin (DB), and alanine transaminase (ALT) were examined, and Child-Pugh scoring was conducted.38 of the patient underwent transcatheter arterial chemo-embolization (TACE). One week after drainage the levels of ALT, TB, and DB of the patients undergoing PTCD and stent implantation all decreased in comparison with those before the treatment, the levels of the stent implantation group being significantly lower than those of the PTCD group (P = 0.019, 0.002, and 0.002 respectively), but there was no significant difference in Child-Pugh scale between these 2 group (P = 0.396). One week after TACE the levels of TB, DB, and Child-Pugh scale of the TACE group were all significantly lower than those of the patients without TACE (P = 0.000, 0.002, and 0.002 respectively), however, there was no significant difference in ALT level between these 2 groups (P = 0.834). The cumulative mean survival time was 26.45 weeks [standard error (SE) 4.07], and the mean survival time of the PTCD group was 28.19 weeks (SE, 6.54), not significantly different from that of the stenting groups were [21.38 weeks (SE, 2.51), P = 0.713]. The mean survival time of the TACE group was 43.71 weeks (SE, 8.32), significantly longer than that of the patients without TACE [14.38 weeks (SE, 2.66), P = 0.000]. Stenting is more effective than PTCD on relieving jaundice when the decreasing extent of bilirubin level is concerned. TACE therapy following PTCD and stent implantation will significantly contribute to the survival time of MBO patients.

Double-balloon enteroscopy application in biliary tract disease—its therapeutic and diagnostic functions

On occasion, it is impossible to perform ERCP with a traditional duodenoscope in patients who have had a Billroth II gastrectomy or hepatojejunostomy, and who now have biliary tract problems. Repeat surgery is not a suitable course of action in these patients. Therefore, finding alternative modalities to resolve these obstructions is of great importance. To report successful endoscopic examination and treatment of difficult biliary obstructions by using double-balloon enteroscopy. Five patients. Cases series. Double-balloon enteroscopy (DBE) for biliary tract examination and treatment. We report on 5 patients who underwent Billroth II gastrectomy or biliary tract Roux-en-Y surgery and who later had biliary tract obstruction from various causes. We were unable to perform ERCP with traditional duodenoscopy but successfully completed ERCP with DBE. DBE was originally designed to examine the small intestine. The successful biliary tract cannulation rate when using DBE is lower than with duodenoscope. We performed ERCP by using DBE a total of 5 times, with a successful biliary cannulation rate of 60%. We performed a special-method papillotomy in 2 patients. This method entailed inserting an electric sphincterotome through the percutaneous transhepatic cholangiography and drainage (PTCD) route after performing DBE intubation to the ampulla of Vater. We then successfully completed a papillotomy with an electric sphincterotome under DBE guidance. DBE appears to be a promising alternative in the examination and treatment of biliary tract disease in patients after GI operations such as Billroth II gastrectomy and choledochojejunostomy.

Treatment of biliary obstruction in selected patients by endoscopic ultrasonography (EUS)-guided transluminal biliary drainage

Endoscopic retrograde cholangiopancreatography (ERCP)-guided implantation of a biliary endoprosthesis or stent is the gold standard treatment for biliary obstructions. When the papilla cannot be traversed because there is pyloric or duodenal stenosis, or the catheter cannot be introduced, or because of previous gastrointestinal surgery (Billroth II gastric resection, Whipple procedure, gastrectomy with Roux-en-Y reconstruction), the alternative treatment is considered to be percutaneous transhepatic cholangiography and drainage (PTCD). The aim of the study was to investigate the further alternative of endoscopic ultrasound (EUS)-guided transgastric or transjejunal biliary drainage where PTCD failed or was declined, and particularly, the feasibility and outcome of this option. Over 3 years all appropriate consecutive patients (as defined above) were enrolled in this prospective, observational, single-center, case series study, and patient and intervention data were recorded. Feasibility was characterized by success rate (regression of cholestasis), and outcomes by complication rate, mortality, and follow-up findings. Between November 2002 and December 2005, eight patients (in 10 interventions) underwent this new biliary drainage procedure. The routes were transesophageal (n = 1), transgastric (n = 4), and transjejunal (n = 3, including a rendezvous technique with ERCP [n = 1]). The indications were cholestasis, arising from recurrent tumor growth (n = 5, 62.5%), that included gastric carcinoma after previous gastrectomy (n = 4) and a periampullary carcinoma after previous Whipple procedure (n = 1); arising from Klatskin tumor (n = 2, 25%); and from benign stenosis of a hepaticojejunostomy (n = 1, 12.5%). Five patients (62.5%) received a metal stent, and three (37.5%) had a plastic prosthesis (8.5-Fr double-pigtail). The technical success rate was 90% (9/10) and the clinical success rate was 88.9% (8/9). There was only one case of cholangitis (12.5%) and slight postinterventional pain, but no severe complications such as bleeding or perforation, and no mortality. During follow-up (range 4 weeks to 3 years) re-interventions were needed in two patients (20%) because of increasing cholestasis; these resulted in technical success and clinical improvement. EUS-guided transgastric or transjejunal biliary drainage is a reasonable, feasible and encouraging treatment option in selected patients as indicated, with a low peri-interventional risk. It broadens the therapeutic spectrum but still needs further evaluation and follow-up investigation.

Treatment of hemobilia after percutaneous transhepatic cholangiography and drainage (PTCD)

Treatment of hemobilia after percutaneous transhepatic cholangiography and drainage (PTCD)