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

Abstract

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.

Clinical outcomes of biliary drainage of malignant biliary obstruction due to colorectal cancer metastases: A systematic review

“…Especially the discomfort and risks of an external PTC-drain should not be underestimated. [3,16,[35][36][37] The optimal drainage modality for mCRC patients cannot be determined with the available data, due to the lack of large observational studies and randomised clinical trials. For malignant biliary obstruction in general, ERCP is recommended for extrahepatic strictures and Bismuth type I and II strictures.…”

Endoscopic palliation of biliary obstruction

“…Percutaneous drainage has been found to have similar effectiveness without significant differences in survival time or cost compared to endoscopic biliary drainage . However, percutaneous drainage requires an external outlet for biliary drainage, which creates additional potential complications including pain and discomfort at the abdominal wall, leakage and dislocation of percutaneous tubing, bleeding, and risk of cellulitis . Due to these disadvantages associated with percutaneous drainage, ERCP is recommended as the initial strategy for biliary drainage in MBTO with percutaneous intervention reserved as a secondary option if endoscopic drainage is unsuccessful.…”

Surgical Treatment of Distal Common Bile Duct Malignancy

“…On the other way, in cases that the unresectable condition is diagnosed by imagining or laparoscopy, the endoscopic placement of a biliary stent is preferred. In most cases, the palliation of jaundice is obtained by an endoscopic approach [23,24]. The most common relapse pattern is represented by local recurrence.…”