Çetin Murat ALTAY, Mehmet ONAY, Ali Burak BİNBOĞA

Percutaneous drainage in malignant biliary obstructions: Technical success and complication rates

The study aimed to investigate the effect of biliary obstruction level on the technical success and complication rates of transhepatic percutaneous biliary drainage (TPBD). Patients who underwent TPBD due to malignant biliary obstruction were reviewed retrospectively. The study sample was separated into two groups according to the level of biliary obstruction. Patients with obstruction in the proximal cystic duct formed Group 1, and those in the distal of the cystic duct formed Group 2. The level of obstruction was determined based on magnetic resonance cholangiopancreatography (MRCP), computed tomography (CT) examinations, and intraoperative fluoroscopy images. Passing the biliary obstruction and providing percutaneous internal-external TPBD was determined as technical success. The effects of tumor location on technical success were investigated. In addition, patient demographic data and complication, morbidity, and mortality rates were compared between the two groups. The study included 56 patients, comprising 32 males and 24 females, with a mean age of 58.5 years, as 32.1% (n=18) in Group 1 and 67.9% (n=38) in Group 2. The technical success rate was 94.4% in Group 1 and 100% in Group 2. In Group 1, external drainage only was performed in 1 patient (5.6%) because the obstruction could not be passed despite all manipulations. There was no significant difference in technical success rates between the groups (p>0.05). No major complication was determined in either group. During the procedure, there were minor complications in 3 patients (16.6%) in Group 1 and 3 patients (8.5%) in Group 2. Complication rates were similar in both groups (p>0.05). There was no procedure-related morbidity and mortality. In conclusion, the localization of the biliary obstruction did not affect the technical success and complication rates of PTBD.

PDF

___

1. Saad WE, Wallace MJ, Wojak JC, et al. Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy. JVIR. 2010;21:789-95. 2. Covey AM, Brown KT. Percutaneous transhepatic biliary drainage. Tech Vasc Interv. 2008;11:14-20.
3. Weber A, Gaa J, Rosca B, Born P, Neu B, Schmid RM, et al. Complications of percutaneous transhepatic biliary drainage in patients with dilated and nondilated intrahepatic bile ducts. EJR. 2009;72:412-7.
4. Parasher G, Lee JG. The role of ERCP in pancreaticobiliary malignancies. Adv Dig Endosc ERCP. 2005:120-41.
5. Sauvanet A, Boher J-M, Paye F, et al. Severe jaundice increases early severe morbidity and decreases long-term survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. JACS. 2015;221:380-9.
6. Albores‐Saavedra J, Schwartz AM, Batich K, Henson DE. Cancers of the ampulla of vater: demographics, morphology, and survival based on 5,625 cases from the SEER program. J. Surg. Oncol. 2009;100:598-605. 7. Ryan DP, Hong TS, Bardeesy N. Pancreatic adenocarcinoma. NEJM. 2014;371:1039-49.
8. Aribaş BK, Kemal A, Yakut F, et al. Percutaneous biliary drainage in malignant biliary obstruction and accompanying bilomas. The Turkish Journal of Academic Gastroenterology. 2010;9:16-21.
9. Rizzo A, Ricci AD, Frega G, et al. How to choose between percutaneous transhepatic and endoscopic biliary drainage in malignant obstructive jaundice: an updated systematic review and meta-analysis. In Vivo. 2020;34:1701-14.
10. Choi J, Ryu JK, Lee SH, et al. Biliary drainage for obstructive jaundice caused by unresectable hepatocellular carcinoma: the endoscopic versus percutaneous approach. Hepatobiliary & Pancreatic Diseases Inter. 2012;11:636-42.
11. Saluja SS, Gulati M, Garg PK, et al. Endoscopic or percutaneous biliary drainage for gallbladder cancer: a randomized trial and quality of life assessment. Clin Gastroenterol Hepatol. 2008;6:944-50.
12. Walter T, Ho CS, Horgan AM, Warkentin A, Gallinger S, Greig PD, et al. Endoscopic or Percutaneous Biliary Drainage for Klatskin Tumors? JVIR. 2013;24:113-21.
13. Sainani NI, Catalano OA, Holalkere N-S, et al. Cholangiocarcinoma: current and novel imaging techniques. Radiographics. 2008;28:1263-87.
14. Khashab MA, Valeshabad AK, Afghani E, et al. A comparative evaluation of EUS-guided biliary drainage and percutaneous drainage in patients with distal malignant biliary obstruction and failed ERCP. Dig Dis Sci. 2015;60:557-65.
15. Rerknimitr R, Angsuwatcharakon P, Ratanachu-ek T, et al. Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma. J Gastroenterol Hepatol. 2013;28:593-607.
16. Duan F, Cui L, Bai Y, et al. Comparison of efficacy and complications of endoscopic and percutaneous biliary drainage in malignant obstructive jaundice: a systematic review and meta-analysis. Cancer Imaging. 2017;17:1-7.
17. Jo JH, Chung MJ, Park JY, et al. Best options for preoperative biliary drainage in patients with Klatskin tumors. Surg Endosc. 2017;31:422-9.