Imaging in Obstructive Jaundice: What a Radiologist Needs to Know before Doing a Percutaneous Transhepatic Biliary Drainage

Gupta, Pankaj; Gupta, Jayesh K.; Kumar‐M, Praveen

doi:10.1055/s-0039-3401327

Cited by 17 publications

(19 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Early drainage is warranted in moderate and severe cholangitis [15][16][17][18]. The altered mental state of these patient may pose a challenge for interventional radiologist due to unwanted movements, as well as an inability to follow breath-hold instructions [19]. Use of sedatives or general anesthesia in these patients may pose additional risks.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous transhepatic biliary drainage in patients at higher risk for adverse events: experience from a tertiary care referral center

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background Despite advances in endoscopic drainage procedures, percutaneous transhepatic biliary drainage (PTBD) remains an essential interventional radiology (IR) procedure. Several factors may adversely affect the success of PTBD. We report the experience of our IR unit with PTBD in patients considered at higher risk for adverse events. Material Consecutive PTBDs performed between November 2017 and April 2019 were retrospectively reviewed. The patients at increased risk for adverse events from PTBD, defined by one or more of the following factors: non-dilated system, moderate amount of perihepatic fluid, coagulopathy, altered sensorium, and PTBD performed at bedside, were identified. Technical success, complications, and outcome at 3 months were recorded. Results During the study period, PTBDs were performed in 90 patients. PTBDs in 57 (63.3%) patients (mean age 47.6 years, 35 females) were identified as predisposing to higher risk for adverse events. Left and right PTBD were performed in 37 (64.9%) and 15 (26.3%) patients, respectively. Bilateral PTBDs were performed in three (5.2%) patients. In two (3.5%) cases, biliary access was obtained via percutaneous cholecystostomy. Overall technical success of 91.2% (n = 52) was achieved. Carcinoma gallbladder was the most common underlying cause. Non-dilated ductal system was the most common condition deemed to predispose to higher risk for adverse events (n = 32, 56.1%), followed by perihepatic fluid (n = 9, 15.8%), and deranged coagulation parameters (n = 9, 15.8%). PTBD was performed at bedside in intensive care unit in 5 (8.8%) patients. Two (3.5%) patients had altered sensorium. Major complications in the form of biliary peritonitis were observed in three (5.2%) patients. No procedure-related mortality was observed. Conclusion PTBD can be effectively and safely performed even in situations deemed to predispose patients to increased risk for adverse events. Thus, the mere presence of these conditions should not cause a denial of PTBD.

show abstract

Section: Discussionmentioning

confidence: 99%

Percutaneous transhepatic biliary drainage in patients at higher risk for adverse events: experience from a tertiary care referral center

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…Percutaneous transhepatic biliary drainage involves percutaneous access to the bile ducts and placement of a catheter [ 55 ]. It is typically performed using fluoroscopy or a combined ultrasound and fluoroscopic approach, thus exposing the patient to ionizing radiation.…”

Section: Management Of Hepatobiliary Disordersmentioning

confidence: 99%

Interventional radiological management of hepatobiliary disorders in pregnancy

Rana¹,

Gupta²,

Chaluvashetty³

et al. 2020

ceh

Self Cite

View full text Add to dashboard Cite

“…The condition commonly presents at an advanced stage and has an abysmal prognosis [2,3]. Biliary drainage represents an important palliation strategy for these patients [4]. In general, endoscopic drainage is the preferred choice for malignant lower end biliary obstruction [5].…”

Section: Introductionmentioning

confidence: 99%

Should patients with unresectable gallbladder cancer with hilar involvement undergo unilateral or bilateral percutaneous biliary drainage in the setting of cholangitis?

Gupta

Bansal

Kalra

et al. 2021

ceh

Self Cite

View full text Add to dashboard Cite

Aim of the study: This study aimed to evaluate the outcomes of patients with unresectable gallbladder cancer (GBC) with hilar involvement and cholangitis undergoing percutaneous transhepatic biliary drainage (PTBD). Material and methods: This retrospective study comprised consecutive patients with unresectable GBC with cholangitis who underwent PTBD. The procedures were categorized as unilateral or bilateral. Bilateral PTBD was classified as simultaneous or sequential. The mean reduction in bilirubin at two weeks was recorded. Complications and mean overall survival were also recorded. Results: Thirty-three patients (mean age 54.5 years, 12 males) were included. Thirty patients underwent unilateral drainage. Sequential drainage of the contralateral system was performed in 11 patients. Simultaneous bilateral PTBD was performed in 3 patients. PTBD was technically successful in all patients. Mean reduction in bilirubin was 41.5% in the unilateral group. The fall of bilirubin in the simultaneous bilateral PTBD group was 39%. The mean follow-up duration was 36.5 days. No major complications were encountered. At the last follow-up, 7 patients were alive. The mean overall survival was 34.6 days. Conclusions: Patients with unresectable GBC and cholangitis frequently require bilateral drainage. However, prospective studies should be performed to evaluate whether a sequential or simultaneous PTBD should be performed.

show abstract

Imaging in Obstructive Jaundice: What a Radiologist Needs to Know before Doing a Percutaneous Transhepatic Biliary Drainage

Cited by 17 publications

References 29 publications

Percutaneous transhepatic biliary drainage in patients at higher risk for adverse events: experience from a tertiary care referral center

Percutaneous transhepatic biliary drainage in patients at higher risk for adverse events: experience from a tertiary care referral center

Interventional radiological management of hepatobiliary disorders in pregnancy

Should patients with unresectable gallbladder cancer with hilar involvement undergo unilateral or bilateral percutaneous biliary drainage in the setting of cholangitis?

Contact Info

Product

Resources

About