Clinical Impact of Percutaneous Transhepatic Insertion of Metal Biliary Endoprostheses for Palliation of Jaundice and Facilitation of Chemotherapy

Abstract

TMBE provides acceptable palliation for patients with inoperable MBO who have failed endoscopic drainage. Stents appear to remain patent for the remainder of the patient's life in most cases and may facilitate the first induction or reinstatement of chemotherapy with further clinical response in some patients.

Chemotherapy Improves Survival After Percutaneous Biliary Drainage in Patients With Pancreatic or Biliary Tract Cancer With Biliary Obstruction

“…However, hyperbilirubinemia caused by biliary obstruction precludes the administration of chemotherapy, and these patients have typically been excluded from clinical studies (4,5,8). There are very limited data concerning the utility of chemotherapy for this patient group with malignant biliary obstruction not suitable for endoscopic biliary drainage and therefore treated with PTBD (9)(10)(11)(12).…”

Percutaneous biliary drainage effectively lowers serum bilirubin to permit chemotherapy treatment

“…Because stent or drain selection was influenced by characteristics of the patient's obstruction, and the radiologist's selection of a stent reflected the fact that an obstruction was distal and could be easily traversed, we do not feel these results necessarily reflect improved drainage with stents than with drains. However, it is important to note that metal stents have longer patency than internal/external biliary drainage catheters [13], and a greater number of catheter exchanges are associated with increased probability of bile spillage and cancer dissemination [14]. Therefore, we generally favor stent placement over drain insertion in patients who are appropriate candidates.…”

ACR Appropriateness Criteria® Radiologic Management of Biliary Obstruction

“…A meta-analysis comparing percutaneous versus endoscopic biliary drainage demonstrated no significant difference with regards to mortality, complications, or therapeutic response rates, making percutaneous biliary drainage a validated second-line therapy in these patients [109]. Alternatively, in patients who would otherwise be a candidate for endoscopic internal metallic stent placement, percutaneous placement of self-expanding stents has demonstrated safety and effectiveness similar to their endoscopically placed counterparts [110][111][112].…”