Percutaneous Transhepatic Cholangiography, Percutaneous Biliary Drainage and Metallic Endoprotesis Applications in Malign Biliary Obstructions

Öz

Objective:We aimed to present the effectiveness of percutaneous transhepatic cholangiography, percutaneous biliary drainage and metallic endoprotesis applications in patients with inoperable biliary obstructions. Materials and Methods: Percutaneous transhepatic cholangiographies(PTC) and percutaneous biliary drainages (PBD) were performed in 44 patients with inoperabl malignant obstructive jaundice who had been hospitalized in the radiology department of our hospital over a three years period. Six patients (13.6%) underwent external biliary drainage(EBD), 27 patients (61.4%) underwent internal-external biliary drainage(I-EBD) and metallic stents were placed in 11 patients (25%) on average 6 days (1-34 days) after I-EBD. The mean total bilirubin(TB), ALP, ALT, AST, GGT values taken before and after drainage in all patients were compared. Results: Biliary drainage was technically successful in all patients.İn the first two weeks after biliary drainage, 38 cases (86%) had a general condition improvement, weakness and itching decreased. The mean TB;19,41 ± 9,09; 9,39 ± 15,34, ALP; 701,27 ± 352,53 ; 357,48 ± 268,70, ALT; 122,45 ± 75,42; 62,91 ± 61,90, AST; 129,14 ± 84,31; 94,93 ± 118,79, GGT; 684,48 ± 428,83; 322,39 ± 253,26 values taken before and after drainage in all patients were compared and a significant decrease was found in the post-procedure values (p<0,050). In the follow-up, minor complications were observed in 10 patients (22.7%). Conclusion: It is necessary to prevent inoperable patients from entering hepato-renal failure in order to prolong life time as much as possible. PBD and stent applications significantly improves impaired liver function, allowing the patients general condition improvement. Low complication rates and quickyl improving general condition of patients without need for another surgery gradually increase the value of this radiological intervention.

Anahtar Kelimeler

• Endoprotesis;
• Malign Obstruction;
• Percutaneous Biliary Drainage;

İnoperabl Malign Biliyer Obstrüksiyonlarda Perkütan Transhepatik Kolanjiyografi, Perkütan Biliyer Drenaj ve Metalik Endoprotez Uygulamaları

Öz

Amaç: İnoperabl malign bilier obstrüksiyonlu hastalarda, perkütan transhepatik kolanjiyografi(PTK) sonrasında uygulanan perkütan bilier drenaj(PBD) ve metalik endoprotez uygulamalarının etkinliğini sunmayı amaçladık. Gereç ve Yöntem: Girişimsel radyoloji ünitemize 3 yıllık süre içerisinde refere edilen, malign tıkanma sarılığı olan inopere 44 hastaya, PTK sonrası PBD uygulandı. Altı olguya (%13,6) sadece eksternal bilier drenaj(EBD), 27 olguya (%61,4) sadece internal-eksternal bilier drenaj(İEBD), 11 olguya (%25) ise ortalama 6 gün (1-34 gün) sonra İEBD sonrası metalik stent uygulandı. Drenaj öncesi ve sonrası alınan ortalama total bilirubin(TB), ALP, ALT, AST, GGT değerleri karşılaştırıldı. Bulgular: Hastaların tümünde safra drenajı sağlanarak işlem başarıyla sonlandırıldı. PBD sonrası ilk 2 haftada 38 olgunun (%86) genel durumunda iyileşme, halsizlik ve kaşıntı gibi şikayetlerde azalma saptandı. Tüm hastalarda drenaj öncesi ve sonrası ortalama total bilirubin(TB); 19,41 ± 9,09; 9,39 ± 15,34, ALP; 701,27 ± 352,53 ; 357,48 ± 268,70, ALT; 122,45 ± 75,42; 62,91 ± 61,90, AST; 129,14 ± 84,31; 94,93 ± 118,79, GGT; 684,48 ± 428,83; 322,39 ± 253,26 olarak hesaplandı ve işlem sonrası değerlerde anlamlı düşüş saptandı (p<0,050). Takipte toplam 10 hastada (%22,7) minör komplikasyonlar izlendi. Sonuç: İnoperabl malign tıkanma sarılıklı hastalarda yaşamı mümkün olduğunca uzatabilmek için hastanın hepato-renal yetmezliğe girmesini önlemek gereklidir. Perkütan biliyer drenaj ve biliyer endoprotez uygulamaları, bozulmuş olan hepatik fonksiyonları büyük ölçüde düzelterek hastanın genel durumunun iyileşmesine olanak sağlamaktadır. Bir başka cerrahi müdahale gerekmeden hızlı bir şekilde hastanın genel durumunu iyileştirmesi ve düşük komplikasyon oranları bu radyolojik girişimin değerini giderek artırmaktadır.

Anahtar Kelimeler

• Malign obstrüksiyon;
• Perkütan Biliyer Drenaj;
• Stent;

Kaynakça

1. 1. Pasquali C, Sperti C, Filipponi C, Pedrazzoli S. Epidemiology of pancreatic cancer in Northeastern Italy: incidence, resectability rate, hospital stay, costs and survival (1990-1992). Dig Liver Dis 2002; 34: 723-31.
2. 2. Molnar W, Stockum AE. Relief of Obstructive Jaundice Through Percutaneous Transhepatic Catheter-A New Therapeutic Method. AJR 1974; 122: 356-67.
3. 3. Burchharth F, Jensen LI, Olesen K. Endoprosthesis for Internal Drainage of the Biliary Tract. Gastroenterology 1979; 77: 133–7.
4. 4. Makuuchi M, Yamazaki S, Hasegawa H. Ultrasonically Guided Cholangiography and Bile Drainage. Ultrasound Med Biol 1984; 10: 617-23.
5. 5. Crosara Teixeira M, Mak MP, Marques DF et al. Percutaneous transhepatic biliary drainage in patients with advanced solid malignancies: prognostic factors and clinical outcomes. J Gastrointest Cancer 2013; 44: 398-403.
6. 6. Stanley J, Gobien RP, Cunningham J, Andriole J. Biliary decompression: an institutional comparison of percutaneous and endoscopic methods. Radiology 1986; 158: 195-97.
7. 7. Gwon DI, Ko GY, Sung KB et al. Clinical outcomes after percutaneous biliary interventions in patients with malignant biliary obstruction caused by metastatic gastric cancer. Acta Radiol 2012; 53: 422-9.
8. 8.Riauka R, Ignatavičius P, Barauskas G. Percutaneous transhepatic biliary drainage – the first step in the treatment of malignant biliary obstruction. Biomedicina 2018; 28: 33-37.

9. 9. Lorenz JM. Management of Malignant Biliary Obstruction. Semin Intervent Radiol 2016; 33: 259–267.
10. 10. Berquist TH, May GR, Johnson MC et al. Percutaneous Biliary Decompression: İnternal and Eksternal Drainage in 50 Patients. AJR 1981; 136: 901-906.
11. 11. Akiyama H, Okazaki T, Takasima I et al. Percuteneous Treatments for Biliary Diseases. Radiology 1990; 176: 25-30.
12. 12. Singh S, Sachdev AK, Chaudhary A, Agarwal AK. Palliative surgical bypass for unresectable periampullary carcinoma. Hepatobiliary Pancreat Dis Int 2008; 7: 308-12.
13. 13. McGrath PC, McNeil PM, Neifeld JP et al. Management of Obstruction in Patients with Unresectable Carsinoma of the Pancreas. Ann Surg 1989; 209: 284-88.
14. 14. Langman EL, Suhocki PV, Hurwitz HI et al. Percutaneous biliary drainage catheter insertion in patients with extensive hepatic metastatic tumor burden. J Gastrointest Oncol 2016; 7: 875–81.
15. 15. Feduska NJ, Dent TL, Lindenauer SM. Results of palliative operations for carcinoma of the pancreas. Arch Surg 1971; 103: 330-4.
16. 16. Allison MEM, Prentice CRM, Kennedy AC, Blumgart LH. Renal function and other factors in obstructive jaundice. BJS 1979; 66: 392-97.
17. 17. Dixon JM, Armstrong CP, Duffy SW, Davies GC. Factors affecting morbidity and mortality after surgery for obstructive jaundice: a review of 373 patients. Gut 1983; 24: 845–52.
18. 18. Nakayama T, Ikeda A, Okuda K. Percutaneous transhepatic drainage of the biliary tract. Gastroenterology 1978; 74: 554-59.
19. 19. Pollock TW, Ringer, Olega JA et al. Percutaneous Decompression of Benign and Malignant Obstruction. Arch Surg 1979; 114: 148-151.
20. 20. Gundry SR, Strodel WE, Knol JE et al. Efficacy of Preoperative Biliary Tract Decompression in Patients with Obstuctive Jaundice. Arch Surg 1984; 119: 703-8.
21. 21. Adam A, Chetty N, Roddie M et al. Self-Expandable Stainless Steel Endoprostheses for Treatment of Malignant Bile Duct Obstruction. AJR 1991; 156: 321-25.
22. 22. Carrasco HC, Zornoza J, Bechtel WJ. Malignant Biliary Obstruction: Complications of Percutaneous Biliary Drainage. Radiology 1984; 152: 343-46.
23. 23. Feng GH, Cai Yİ, Jia Z et al. Interventional therapy of malignant obstructive jaundice. Hepatobiliary Pancreat Dis İnt 2003; 2: 300-2.
24. 24. Kozlov AV, Polikarpov AA, Oleshchuk NV, Tarazov PG. Comparitive assesment of percutaneous transhepatic cholangiodrainage under roentgenoscopy and ultrasound guidance. Vestn Rentgenol Radiol 2002; 4: 30-3.
25. 25. Kariya CM, Wach MM, Ruff SM et al. Postbiliary drainage rates of cholangitis are impacted by procedural technique for patients with supra-ampullary cholangiocarcinoma: A SEER-Medicare analysis. J Surg Oncol 2019; 120: 249-255.
26. 26.Huguet JM, Lobo M, Labrador JM, et al. Diagnostic-therapeutic management of bile duct cancer. World J Clin Cases 2019; 7: 1732–1752.
27. 27. Sukkarieh Chelala A, Menassa L, Slaba S, Atallah N. Percutaneous bile drainage in neoplastic obstructive pathology of the biliary tract: Experience of the Hotel-Dieu of France in 100 drainages. J Med Liban 1996; 44: 187-94.
28. 28. Thornton RH, Ulrich R, Hsu M et al. Outcomes of patients undergoing percutaneous biliary drainage to reduce bilirubin for administration of chemotherapy. J Vasc Interv Radiol 2012; 23: 89-95.
29. 29. Deipolyi AR, Covey AM. Palliative Percutaneous Biliary Interventions in Malignant High Bile Duct Obstruction. Semin Intervent Radiol 2017; 34: 361–368.