A review of percutaneous transhepatic biliary drainage at a tertiary referral centre

Asadi, Hamed; Hollingsworth, Renee; Pennycooke, K.; Thanaratnam, P; Given, Mark F.; Keeling, Aoife N.; Lee, M

doi:10.1016/j.crad.2016.05.013

Cited by 14 publications

(6 citation statements)

References 19 publications

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“…Some kind of AE after external PTBD was common and early mortality was high in our patient group with advanced malignant disease, which has also been reported by others (10, 14–16). In most other reports, pain associated with local discomfort or increased demand of opioid treatment has not been included among complications or AEs (16–20).…”

Section: Discussionsupporting

confidence: 89%

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Palliation of Malignant Biliary Obstruction: Adverse Events are Common after Percutaneous Transhepatic Biliary Drainage

et al. 2017

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Inclusion criteria were fulfilled in 140 patients. Median age was 70 years (33-91 years). Some 126 patients had a remaining external percutaneous transhepatic biliary drainage. Jaundice was the initial symptom in 62 patients (44%). Within the first week after percutaneous transhepatic biliary drainage, the bilirubin decreased from 237 µmol/L (31-634) to 180 µmol/L (17-545). Only 25% reached a level below the double upper reference value. Pruritus occurred in 27% before the percutaneous transhepatic biliary drainage, but the bilirubin value did not differ from patients without pruritus. However, the pruritus was relieved in 56% with percutaneous transhepatic biliary drainage. Antibiotic prophylaxis protected to some extent from infectious complications. Adverse events were common and early mortality was high (16% within 14 days). Jaundice should not by itself be an indication for percutaneous transhepatic biliary drainage for palliation except when the aim is to prepare the patient for chemotherapy. It is mandatory that the patients are informed carefully about what can be expected regarding the positive effects and the risks of adverse events.

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Section: Discussionsupporting

confidence: 89%

“…Our and other studies report a significant decrease in plasma bilirubin during the first week after PTBD (5,14,15). Pruritus is often out of proportion to the serum bilirubin level and its pathogenesis is poorly understood (13).…”

Section: Discussionmentioning

confidence: 48%

Palliation of Malignant Biliary Obstruction: Adverse Events are Common after Percutaneous Transhepatic Biliary Drainage

et al. 2017

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“…Our data demonstrates that cholangitis and drain dislodgement are the two most common adverse events after percutaneous drainage, which is in accordance with the data published by Nennstiel et al and Asadi et al [7,29].…”

Section: Plos Onesupporting

confidence: 93%

Percutaneous transhepatic drainage is safe and effective in biliary obstruction—A single-center experience of 599 patients

Kokas

Szíjártó²,

Farkas³

et al. 2021

PLoS ONE

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Background Historically, surgical bilioenteric bypass was the only treatment option for extrahepatic bile duct obstruction, but with technological advancements, percutaneous transhepatic drainage (PTD) and endoscopic solutions were introduced as a less invasive alternative. Endoscopic methods may lead to a decreasing indication of PTD in the future, but today it is still the standard treatment method, especially in hilar obstructions. Methods In our retrospective data analysis, we assessed technical success rate, reintervention rate, morbidity, mortality, and the learning curve of patients treated with PTD over 12 years in a tertiary referral center. Results 599 patients were treated with 615 percutaneous interventions. 94.5% (566/599) technical success rate; 2.7% (16/599) reintervention rate were achieved. 111 minor and 22 major complications occurred including 1 case of death. In perihilar obstruction, cholangitis were significantly more frequent in cases where endoscopic retrograde cholangiopancreatography had also been performed prior to PTD compared to PTD alone, with 39 (18.2%) and 15 (10.5%) occurrences, respectively. Discussion The results and especially the excellent success rates demonstrate that PTD is safe and effective, and it is appropriate for first choice in the treatment algorithm of perihilar stenosis. Ultimately, we concluded that PTD should be performed in experienced centers to achieve low mortality, morbidity, and high success rates.

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“…The reported rate of signi cant bleeding after PTBD varies from 0.6-12%. Most large case series report a 2-2.5% severe bleeding rate [19,20,21]. Quality improvement guidelines for PTBD published in 2010 reported that the average rate of hemorrhage was 2.5% and suggested a speci c threshold rate of 5% [3].…”

Section: Discussionmentioning

confidence: 99%

Bleeding after Ultrasound-Guided Percutaneous Transhepatic Biliary Drainage in Patients with Coagulopathy: A Single Center Experience

Su¹,

Zhuang²,

Li³

et al. 2023

Preprint

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Background To compare the rate of bleeding for ultrasound-guided Percutaneous Transhepatic Biliary Drainage (PTBD) in patients with coagulopathy to that in patients with normal coagulation. Methods This retrospective study included a total of 837 patients who underwent PTBDs from January 2016 to December 2017. The latest coagulation parameters before PTBD were acquired in all patients. The incidence of PTBD-related bleeding was determined, and the association between bleeding and coagulopathy was evaluated. Coagulopathy referred to elevated INR (International Normalized Ratio, > 1.5) or thrombocytopenia (Platelet or PLT < 50×109/L). In this study, highest value of INR was 3.67 and lowest value of PLT was 31×109/L. Results Overall, 32of 837 patients (3.8%) experienced bleeding, 28 (3.3%) for mild bleeding and 4 (0.5%) for severe bleeding. Incidence of bleeding in patients with abnormal PLT and INR values wasn’t significantly different from those in patients with normal PLT (p = 0.769) and INR (p = 0.511). No bleeding was detected in patients with thrombocytopenia. Three cases of mild bleeding were observed in patients with INR > 1.5 (n = 60), no severe bleeding was detected. Impaired coagulopathy function was not found in patients with severe bleeding. Age (p = 0.152), gender (p = 0.094) and underlying diseases (p = 0.318) didn’t correlate significantly with the incidence or severity of PTBD-related bleeding. Conclusions In our study, patients with thrombocytopenia (30×109/L < PLT < 50×109/L) or increased INR (> 1.5) didn’t suffer from higher incidence of or more severe bleeding after PTBD.

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A review of percutaneous transhepatic biliary drainage at a tertiary referral centre

Cited by 14 publications

References 19 publications

Palliation of Malignant Biliary Obstruction: Adverse Events are Common after Percutaneous Transhepatic Biliary Drainage

Palliation of Malignant Biliary Obstruction: Adverse Events are Common after Percutaneous Transhepatic Biliary Drainage

Percutaneous transhepatic drainage is safe and effective in biliary obstruction—A single-center experience of 599 patients

Bleeding after Ultrasound-Guided Percutaneous Transhepatic Biliary Drainage in Patients with Coagulopathy: A Single Center Experience

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