Drainage-related Complications in Percutaneous Transhepatic Biliary Drainage

Nennstiel, Simon; Weber, Andreas; Frick, Günter; Haller, Bernhard; Meining, Alexander; Schmid, Roland M.; Neu, Bruno

doi:10.1097/mcg.0000000000000275

Cited by 170 publications

(151 citation statements)

References 39 publications

(33 reference statements)

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“…Title and abstracts of the reports were screened by first author Kwan JR, and any doubt was clarified by senior author Shelat VG. The findings are presented in Table 1 345678910…”

Section: Discussionmentioning

confidence: 99%

Percutaneous transhepatic biliary drainage catheter fracture: A case report

Kwan

Low

Lohan

et al. 2018

Ann Hepatobiliary Pancreat Surg

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Percutaneous transhepatic biliary drainage (PTBD) is safe treatment for biliary decompression given certain indications. However, this is temporary until definitive drainage is established. We report on a 76-year-old lady with recurrent pyogenic cholangitis and PTBD catheter fracture. She had hepatitis B virus-related Child-Pugh class A liver cirrhosis, hypothyroidism, hyperlipidaemia, and previous atrial fibrillation with a background of mild mitral, tricuspid and aortic valvular regurgitation. She had history of laparoscopic cholecystectomy in the past. She was deemed to be a high operative risk and declined hepatic resection. She had undergone multiple endoscopic and percutaneous biliary interventions to control sepsis and stone burden. A bilateral PTBD catheter was left in situ with plans for 3-monthly change. However, she defaulted follow-up and presented 11 months later with complaints of pain over the drain site and inability to flush the right catheter. Abdominal X-ray and computed tomography scans detected right catheter fracture at two places, making three fragments. She underwent percutaneous removal of the proximal fragment by an interventional radiology team. A temporary 4 Fr catheter was inserted to maintain biliary access. Endoscopic removal of the intra-biliary fragments was done the next day. Complete removal was confirmed on fluoroscopy. Finally, the 4 Fr catheter was replaced by a new 12 Fr catheter. The patient was discharged well.

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“…Title and abstracts of the reports were screened by first author Kwan JR, and any doubt was clarified by senior author Shelat VG. The findings are presented in Table 1 345678910…”

Section: Discussionmentioning

confidence: 99%

Percutaneous transhepatic biliary drainage catheter fracture: A case report

Kwan

Low

Lohan

et al. 2018

Ann Hepatobiliary Pancreat Surg

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“…The adverse events profile of these procedures is significantly high. Data show that drain occlusion, dislocation and cholangitis are the common complications with long-term PTBD therapy that lead to frequent interventions and long-term hospital stay 28. Also, patients are left with a long-term external drain which remains with the patients till the end of life, thereby, leading to poor quality of life 19.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage after failed endoscopic retrograde cholangiopancreatography: a meta-analysis

Baniya¹,

Upadhaya²,

Madala³

et al. 2017

CEG

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The failure rate of endoscopic retrograde cholangiopancreatography for biliary cannulation is approximately 6%–7% in cases of obstructive jaundice. Percutaneous transhepatic biliary drainage (PTBD) is the procedure of choice in such cases. Endoscopic ultrasound-guided biliary drainage (EGBD) is a novel technique that allows biliary drainage by echoendoscopy and fluoroscopy using a stent from the biliary tree to the gastrointestinal tract. Information in PubMed, Scopus, clinicaltrials.gov and Cochrane review were analyzed to obtain studies comparing EGBD and PTBD. Six studies fulfilled the inclusion criteria. Technical (odds ratio (OR): 0.34; confidence interval (CI) 0.10–1.14; p=0.05) and clinical (OR: 1.48; CI 0.46–4.79; p=0.51) success rates were not statistically significant between the EGBD and PTBD groups. Mild adverse events were nonsignificantly different (OR: 0.36; CI 0.10–1.24; p=0.11) but not the moderate-to-severe adverse events (OR: 0.16; CI 0.08–0.32; p≤0.00001) and total adverse events (OR: 0.34; CI 0.20–0.59; p≤0.0001). EGBD is equally effective but safer than PTBD.

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“…Percutaneous transhepatic biliary drainage (PTBD) is a rescue procedure used after failed ERCP [5]. The technical success rate of PTBD is reportedly more than 95%; the adverse events associated with PTBD are bleeding, infection, dislodgement, bile leak, and tract seeding, with overall rates of 33% or higher [6,7]. Although PTBD is an established rescue procedure for ERCP, PTBD is uncomfortable to the patient because of the external drainage catheter, and is not suitable when ascites or multiple liver metastasis are present [7].…”

Section: Introductionmentioning

confidence: 99%

“…The technical success rate of PTBD is reportedly more than 95%; the adverse events associated with PTBD are bleeding, infection, dislodgement, bile leak, and tract seeding, with overall rates of 33% or higher [6,7]. Although PTBD is an established rescue procedure for ERCP, PTBD is uncomfortable to the patient because of the external drainage catheter, and is not suitable when ascites or multiple liver metastasis are present [7]. Since endoscopic ultrasound (EUS)-guided cholangiography was first described in 1996 [8], EUS-guided biliary drainage (EUS-BD) has been an evolving alternative to PTBD [4,9-11], with advantages over PTBD that include drainage internally and a single session procedure by the same operator, even after failed ERCP.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Ultrasound-Guided Biliary Access, with Focus on Technique and Practical Tips

Paik¹,

Park²

2017

Clin Endosc

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In 1980, endoscopic ultrasound (EUS) was introduced as a diagnostic tool for evaluation of the pancreas. Since the introduction of curvilinear-array echoendoscopy, EUS has been used for a variety of gastrointestinal interventions, including fine needle aspiration, tumor ablation, and pancreatobiliary access. One of the main therapeutic roles of EUS is biliary drainage as an alternative to endoscopic retrograde biliary drainage (ERBD) or percutaneous transhepatic biliary drainage (PTBD). This article summarizes three different methods of EUS-guided biliary access, with focus on technique and practical tips.

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Drainage-related Complications in Percutaneous Transhepatic Biliary Drainage

Abstract: Drainage-related complications are a major problem in PTBD therapy. The risk factors for occlusion and cholangitis discovered in this study can help to refine individual strategies to reduce the rate of these drainage complications.

Cited by 170 publications

References 39 publications

Percutaneous transhepatic biliary drainage catheter fracture: A case report

Percutaneous transhepatic biliary drainage catheter fracture: A case report

Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage after failed endoscopic retrograde cholangiopancreatography: a meta-analysis

Endoscopic Ultrasound-Guided Biliary Access, with Focus on Technique and Practical Tips

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