CIRSE Standards of Practice on Percutaneous Transhepatic Cholangiography, Biliary Drainage and Stenting

Das, Marco; Leij, Christiaan van der; Katoh, Marcus; Benten, Daniel; Hendriks, Babs M. F.; Hatzidakis, Adam

doi:10.1007/s00270-021-02903-4

Cited by 14 publications

(9 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This result is in accordance with the previous literature. Percutaneous transhepatic biliary drainage complication rates vary in the literature between 4% and 12% [ 4 ]. The complication rate in our study was not a statistically significant predictor of 60-day survival, was in the range stated in previous literature, and aligned with published standards of practice [ 4 , 50 ].…”

Section: Discussionmentioning

confidence: 99%

“…It is often incurable and associated with very poor prognosis [ 2 ]. The most frequent causes of MBO include pancreatic adenocarcinoma, cholangiocarcinoma, gallbladder adenocarcinoma, liver metastasis, ampullary and duodenal adenocarcinoma, gastric cancer, hepatocellular carcinoma, and compressive metastatic hilar lymph nodes [ 3 , 4 ]. Jaundice is the main sign of bile duct obstruction.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prognostic Nutritional Index (PNI) and Neutrophil to Lymphocyte Ratio (NLR) as Predictors of Short-Term Survival in Patients with Advanced Malignant Biliary Obstruction Treated with Percutaneous Transhepatic Biliary Drainage

Zakosek

Bulatović

Pavlović

et al. 2022

JCM

View full text Add to dashboard Cite

Background: Effective biliary tree decompression plays a central role in the palliation of malignant biliary obstruction (MBO). When endoscopic drainage is unfeasible or unsuccessful, percutaneous transhepatic biliary drainage (PTBD) is the method of choice and preferred treatment approach in advanced hilar MBO. The prognostic nutritional index (PNI) reflects the patient’s immunonutritional status, while the neutrophil to lymphocyte ratio (NLR) reflects the patient’s inflammation status. The aim of the present study was to evaluate the prognostic value of preprocedural PNI and NLR on short-term survival in the advanced stage MBO population threatened with PTBD and to characterize the differences in immunonutritional and inflammatory status between 60-day survivors and non-survivors, as well as analyze other variables influencing short-term survival. Methods: This single-center retrospective study was conducted on patients undergoing palliative PTBD caused by MBO as a definitive therapeutic treatment between March 2020 and February 2022. After the procedure, patients were followed until the end of August 2022. Results: A total of 136 patients with malignant biliary obstruction were included in the study. Based on receiver operating characteristic (ROC) curve analysis, optimal cut off-values for NLR (3) and PNI (36.7) were determined. In univariate regression analysis, age, absolute neutrophil count, albumin level, NLR ≤ 3, and PNI ≥ 36.7 were significant predictors of 60-day survival. Level of obstruction and PNI ≥ 36.7 were statistically significant independent predictors of 60-day survival in a multivariate regression model. Using PNI ≥ 36.7 as a significant coefficient from the multivariate regression model with the addition of NLR ≤ 3 from univariate analysis, a 60-day survival score was developed. Conclusions: PNI and NLR are easy to calculate from routine blood analysis, which is regularly conducted for cancer patients. As such, they represent easily available, highly reproducible, and inexpensive tests capable of expressing the severity of systemic inflammatory responses in patients with cancer. Our study highlights that preprocedural PNI and NLR values provide predictors of short-term survival in patients with MBO treated with palliative PTBD. In addition, the proposed 60-day survival score can contribute to better selection of future candidates for PTBD and recognition of high-risk patients with expected poor outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prognostic Nutritional Index (PNI) and Neutrophil to Lymphocyte Ratio (NLR) as Predictors of Short-Term Survival in Patients with Advanced Malignant Biliary Obstruction Treated with Percutaneous Transhepatic Biliary Drainage

Zakosek

Bulatović

Pavlović

et al. 2022

JCM

View full text Add to dashboard Cite

show abstract

“…The first stage was percutaneous transhepatic biliary drainage (PTBD) and the second stage was MCS placement. All procedures were performed in the angiography suite, according to the CIRSE Standards of Practice on Percutaneous Transhepatic Cholangiography, Biliary Drainage and Stenting[ 21 ] using local anesthesia (2% Lidocaine), and conscious sedation (Fentanyl and Midazolam). A single-dose of iv antibiotic prophylaxis (Cefprozil 1g) was administrated before each procedure.…”

Section: Methodsmentioning

confidence: 99%

Percutaneous insertion of a novel dedicated metal stent to treat malignant hilar biliary obstruction

Cortese¹,

Acquafredda²,

Mardighian³

et al. 2022

WJGO

View full text Add to dashboard Cite

BACKGROUND Percutaneous bilateral biliary stenting is an established method for the management of unresectable malignant hilar biliary obstruction. AIM To evaluate the efficacy and safety of a novel uncovered biliary stent, specifically designed for hilar reconstruction. METHODS This, single-center, retrospective study included 18 patients (mean age 71 ± 11 years; 61.1% male) undergoing percutaneous transhepatic Moving cell stent (MCS) placement for hilar reconstruction using the stent-in-stent technique for malignant biliary strictures, between November 2020 and July 2021. The Patients were diagnosed with cholangiocarcinoma (12/18; 66.6%), gallbladder cancer (5/18; 27.7%), and colorectal liver metastasis (1/18; 5.5%). Primary endpoints were technical (appropriate stent placement) and clinical (relief from jaundice) success. Secondary endpoints included stent patency, overall survival, complication rates and stent-related complications. RESULTS The technical and clinical success rates were 100% (18/18 cases). According to Kaplan-Meier analysis, the estimated overall patient survival was 80.5% and 60.4% at 6 and 12 mo respectively, while stent patency was 90.9% and 68.2% at 6 mo and 12 mo respectively. The mean stent patency was 172.53 ± 56.20 d and median stent patency was 165 d (range 83-315). Laboratory tests for cholestasis significantly improved after procedure: mean total bilirubin decreased from 15.2 ± 6.0 mg/dL to 1.3 ± 0.4 mg/dL ( P < 0.001); mean γGT decreased from 1389 ± 832 U/L to 114.6 ± 53.5 U/L ( P < 0.001). One periprocedural complication was reported. Stent-related complications were observed in 5 patients (27.7%), including 1 occlusion (5.5%) and 1 stent migration (5.5 %). CONCLUSION Percutaneous hilar bifurcation biliary stenting with the MCS resulted in excellent clinical and technical success rates, with acceptable complication rates. Further studies are needed to confirm these initial positive results.

show abstract

“…3). Al- though early self-limiting hemobilia has been reported in up to 20% of the cases treated interventionally, the rate of bleeding complications requiring additional measures is reported at around 2.5% [61]. Imagingguided percutaneous drainage of bilomas should be done if immediate surgical repair is not indicated.…”

Section: Biliary Interventionsmentioning

confidence: 99%

Interventional Radiology Options after Visceral Surgery

et al. 2022

View full text Add to dashboard Cite

Background: Postoperative management of patients undergoing visceral surgery can present challenging clinical situations with significant morbidity and mortality. Interventional radiological techniques offer quick, safe, and effective minimally invasive treatment options in the postoperative management of visceral surgery. Summary: Most commonly done procedures include – but are not limited to – fluid or abscess drainage, biliary diversion, bleeding embolization, and re-canalization of a thrombosed vessel. While bleeding from side branches after hepatobiliary and pancreatic surgeries can be managed by coil embolization, the hepatic arterial injury should be managed by stent-graft placement. Hepatic venous complications can require a transhepatic or transjugular approach, whereas the transjugular intrahepatic portosystemic shunt approach has a higher clinical success rate in patients with portal vein thrombosis. Biliary leakages require multidisciplinary management, and interventional radiology can offer an efficient treatment, especially in patients with biliodigestive anastomosis. Key Messages: Interventional radiology provides a broad spectrum of procedures in the management of patients with recent visceral surgery.

show abstract

CIRSE Standards of Practice on Percutaneous Transhepatic Cholangiography, Biliary Drainage and Stenting

Cited by 14 publications

References 53 publications

Prognostic Nutritional Index (PNI) and Neutrophil to Lymphocyte Ratio (NLR) as Predictors of Short-Term Survival in Patients with Advanced Malignant Biliary Obstruction Treated with Percutaneous Transhepatic Biliary Drainage

Prognostic Nutritional Index (PNI) and Neutrophil to Lymphocyte Ratio (NLR) as Predictors of Short-Term Survival in Patients with Advanced Malignant Biliary Obstruction Treated with Percutaneous Transhepatic Biliary Drainage

Percutaneous insertion of a novel dedicated metal stent to treat malignant hilar biliary obstruction

Interventional Radiology Options after Visceral Surgery

Contact Info

Product

Resources

About