Percutaneous transhepatic biliary drainage for obstructive jaundice caused by metastatic gastric cancer: efficacy and complications

Abstract

Objective: The aim of our study was to evaluate the efficacy and incidence of complications of percutaneous transhepatic biliary drainage (PTBD) as palliative treatment of obstructive jaundice caused by metastatic gastric cancer. Methods: Hospital records were reviewed for 32 consecutive patients with biliary obstruction caused by metastatic gastric cancer who underwent PTBD at our institution between October 2004 and April 2010. Patients (23 males and 9 females) age ranged from 35 to 72 years. The indexes of hepatic function before PTBD and within one month after PTBD were compared. The incidence of complications and corresponding treatments were also documented. Results: The level of obstruction was defined as the distal bile duct (beyond the level of the liver hilum) in 22 patients (group 1) and the liver hilum in 10 patients (group 2). Successful decompression of the biliary system after PTBD was defined by a total bilirubin decrease of more than 30% of the baseline value. Success rates were 100% (22/22) for group 1, 70% (7/10) for group 2, and 90.6% (29/32) for all patients. Differences in success rates between group 1 and group 2 were significant (P = 0.024). Serum TBIL, ALT, and AST significantly decreased from (292.8 ± 179.9) μmol/L, (174.5 ± 107.4) IU/L, (159.9 ± 103.9) IU/L before PTBD to (111.5 ± 92.5) μmol/L, (58.5 ± 46.3) IU/L, (59.6 ± 48.9) IU/L, respectively within one month after PTBD (P < 0.05). Complications associated with PTBD included cholangitis in 13 patients (40.5%), drainage tube displacement in 6 patients (18.8%), hemobilia in 4 patients (12.5%), tube occlusion in 2 patients (6.3%), and pancreatitis in 1 patient (3.1%). All complications were successfully treated with appropriate measures. Conclusion: Hepatic function can be improved by PTBD without serious complications in patients with obstructive jaundice caused by metastatic gastric cancer.

Percutaneous Transhepatic Biliary Drainage – The First Step in the Treatment of Malignant Biliary Obstruction

“…The main objective of our study was to analyze the clinical outcomes of ultrasound guided PTBD and its role in further palliative treatment of malignant biliary diseases. Clinical success is described as a certain amount of reduction in serum bilirubin values after the PTBD, as compared to these values prior to drainage procedure [5,15]. Similarly, we have shown significantly reduced bilirubin and liver enzyme values after PTBD, indicating satisfactory clinical effectiveness.…”