Percutaneous Transhepatic Biliary Drainage: A Single-Center Retrospective Study

Abstract

Background: Percutaneous transhepatic biliary drainage is a procedure commonly used in malign and benign biliary pathologies. The aim of this study is to evaluate the effectiveness, complication rates and results of percutaneous transhepatic biliary drainage.
Materials and Methods: 49 patients, to whom percutaneous transhepatic biliary drainage was performed due to different malignant and benign pathologies between April 2018 and April 2020 in the interventional radiology de-partment of our hospital, were included in the study. 26 of the patients were male, and 23 were female. The ages of the patients ranged between 8 and 87, and the mean age was 62.18±15.8. External drainage catheter was inserted in 11 patients, and internal-external drainage catheter in 38 patients. Metallic stent was inserted in two patients. The efficiency of the procedures was evaluated according to the comparison of preprocedural and postprocedural direct and total bilirubin values and the improvement in clinical findings. Procedure-related early and late complica-tions were obtained.
Results: Technical success was achieved in all patients who underwent percutaneous transhepatic biliary drainage. The preprocedural and postprocedural total bilirubin median values were 16.2 mg/dl (0.6-30.5) and 6.3 mg/dl (0.7-26.9), respectively. The preprocedural and postprocedural direct bilirubin median values were 11.9 mg/dl (0.3-15) and 4.3 mg/dl (0.2-15) , respectively. The decrease in the total and direct bilirubin values was found to be significant (p<0.001). Major and minor complications developed in 13 patients in the early and late stages.
Conclusions: Percutaneous transhepatic biliary drainage is an efficient method in decompression of malignant biliary obstructions, palliation of the disease and treatment of benign biliary pathologies.

Key Words: Percutaneous, Biliary Drainage, Transhepatic

Keywords

• Percutaneous
• Biliary Drainage
• Transhepatic
• Percutaneous, Biliary Drainage, Transhepatic

Perkütan Transhepatik Biliyer Drenaj: Tek Merkezli Retrospektif Çalışma

Abstract

Amaç: Perkütan transhepatik biliyer drenaj malign ve benign biliyer patolojilerde sıklıkla uygulanan bir işlemdir.Bu çalışmanın amacı perkütan transhepatik biliyer drenajın etkinliğini, komplikasyon oranlarını ve sonuçlarını değerlendirmektir. Materyal ve metod: Çalışmaya hastanemiz girişimsel radyoloji bölümünde Nisan 2018- Nisan 2020 tarihleri arasında farklı malign ve benign patolojiler nedeniyle perkütan transhepatik biliyer drenaj uygulanan 49 hasta dahil edildi. Hastaların 26 ' sı erkek, 23 tanesi kadın cinsiyetteydi. Hastaların yaşları 8-87 arasında değişmekte olup ortalama 62.18±15.8 idi. Hastaların 11 tanesine eksternal drenaj kateteri 38 tanesine internal-eksternal drenaj kateteri takıldı.İki hastaya metalik stent takıldı. Yapılan işlemlerin etkinliği işlem öncesi ve işlem sonrası direkt ve total bilirübin değerlerinin karşılaştırılması ve klinik bulgulardaki düzelmeye göre değerlendirildi. İşleme bağlı erken ve geç dönem komplikasyonlar elde edildi. Bulgular: İşlem yapılan hastaların tamamında teknik başarı sağlandı. Total bilirübin ortanca değerleri işlem öncesi 16.2 mg/dl (0.6-30.5) , işlem sonrası 6.3 mg/dl (0.7-26.9) olarak elde edildi. Direkt bilirübin ortanca değerleri işlem öncesi 11.9 mg/dl (0.3-15), işlem sonrası 4.3 mg/dl (0.2-15) idi. Total ve direkt bilirübin değerlerindeki düşüş anlamlı bulundu (p<0.001). İşleme bağlı erken ve geç dönemde 13 hastada majör ve minör komplikasyon gelişti. Sonuç: Perkütan transhepatik biliyer drenaj malign biliyer obstrüksiyonların dekompresyonunda, hastalığın palyasyonunda ve benign biliyer patolojilerin tedavisinde etkili bir yöntemdir.

Keywords

• perkütan
• biliyer drenaj
• transhepatik

References

1. 1. Covey AM, Brown KT. Percutaneous transhepatic biliary drainage. Tech Vasc Interv Radiol 2008;11: 14.
2. 2. Kim ES, Lee BJ, Won JY, Choi JY, Lee DK. Percutaneous transhepatic biliary drainage may serve as a successful rescue procedure in failed cases of endoscopic therapy for a post-living donor liver transplantation biliary stricture. Gastrointest Endosc 2009; 69: 38-46.
3. 3. Van Delden OM, Laméris JS. Percutaneous drainage and stenting for palliation of malignant bile duct obstruction. Eur Radiol 2008; 18: 448-56.
4. 4. Makino T, Fujitani K, Tsujinaka T, Hirao M, Kashiwazaki M, Nakamori S, et al. The role of percutaneous transhepatic biliary drainage in patients with obstructive jaundice caused by local recurrence of gastric cancer. Hepatogastroenterology 2008; 55: 54-7.
5. 5. Venbrux AC, Osterman FA Jr. Percutaneous management of benign biliary strictures. Tech Vasc Interv Radiol 2001; 4: 141-6
6. 6. Zhang GY, Li WT, Peng WJ, Li GD, He XH, Xu LC. Clinical outcomes and prediction of survival following percutaneous biliary drainage for malignant obstructive jaundice. Oncol Lett. 2014;7:1185-90.
7. 7. Chu D, Adler DG. Malignant biliary tract obstruction: Evaluation and therapy. J. Natl Compr. Canc. Netw. 2010; 8: 1033–44.
8. 8. Zhao XQ, Dong JH, Jiang K, Huang XQ, Zhang WZ. Comparison of percutaneous transhepatic biliary drainage and endoscopic biliary drainage in the management of malignant biliary tract obstruction: a meta-analysis. Dig Endosc. 2015 ;27:137-45.

9. 9. Crosara Teixeira M, Mak MP, Marques DF, Capareli F, Carnevale FC, Moreira AM, et al. Percutaneous transhepatic biliary drainage in patients with advanced solid malignancies: Prognostic factors and clinical outcomes. J Gastrointest Cancer. 2013;44:398–403.
10. 10. Csendes A, Diaz C, Burdiles P, Nava O, Yarmuch J, Maluenda F, et al. Indications and results of hepaticojejunostomy in benign strictures of the biliary tract. Hepatogastroenterology, 1992; 39: 333-6.
11. 11. Kapoor BS, Mauri G, Lorenz JM. Management of Biliary Strictures: State-of-the-Art Review. Radiology. 2018;289:590-603.
12. 12. Frattaroli FM, Reggio D, Guadalaxara A, Illomei G, Pappalardo G. Benign biliary strictures: a review of 21 years of experience. J Am Coll Surg, 1996; 183: 506-13.
13. 13. Lillemoe KD, Pitt HA, Cameron JL. Current management of benign bile duct strictures. Adv Surg, 1992; 25: 119-74.
14. 14. Born P, Rösch T, Brühl K, Sandschin W, Allescher HD, Frimberger E, et al. Long-term results of endoscopic and percutaneous transhepatic treatment of benign biliary strictures. Endoscopy, 1999; 31: 725-31.
15. 15. Schumacher B, Othman T, Jansen M, Preiss C, Neuhaus H. Long-term follow-up of percutaneous transhepatic therapy (PTT) in patients with definite benign anastomotic strictures after hepaticojejunostomy. Endoscopy, 2001; 33: 409-15.
16. 16. 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. Eur J Radiol 2009;72:412-7.
17. 17. Pappas P, Leonardou P, Kurkuni A, Alexopoulos T, Tzortzis G. Percutaneous insertion of metallic endoprostheses in the biliary tree in 66 patients: relief of the obstruction. Abdom Imaging 2003;28:678-83.
18. 18. Berquist TH, May GR, Johnson CM, Adson MA, Thistle JL. Percutaneous biliary decompression: internal and external drainage in 50 patients. Am J Radiol 1981;136(5):901–6.
19. 19. Clark CD, Picus D, Dunagan WC. Bloodstream infections after interventional procedures in the biliary tract. Radiology 1994;191:495–9.
20. 20. Arıbaş B. K. , Arda K. , Yakut F. , Yılmaz K. , Doğan K. , Şahin G. , Coşar Y. Malign bilier obstrüksiyonlarda ve eşlik eden bilomalarda perkütan bilier drenaj. Akademik Gastroenteroloji Dergisi 2010;9:16-21.