Percutaneous transhepatic drainage is safe and effective in biliary obstruction—A single-center experience of 599 patients

Abstract

Background Historically, surgical bilioenteric bypass was the only treatment option for extrahepatic bile duct obstruction, but with technological advancements, percutaneous transhepatic drainage (PTD) and endoscopic solutions were introduced as a less invasive alternative. Endoscopic methods may lead to a decreasing indication of PTD in the future, but today it is still the standard treatment method, especially in hilar obstructions. Methods In our retrospective data analysis, we assessed technical success rate, reintervention rate, morbidity, mortality, and the learning curve of patients treated with PTD over 12 years in a tertiary referral center. Results 599 patients were treated with 615 percutaneous interventions. 94.5% (566/599) technical success rate; 2.7% (16/599) reintervention rate were achieved. 111 minor and 22 major complications occurred including 1 case of death. In perihilar obstruction, cholangitis were significantly more frequent in cases where endoscopic retrograde cholangiopancreatography had also been performed prior to PTD compared to PTD alone, with 39 (18.2%) and 15 (10.5%) occurrences, respectively. Discussion The results and especially the excellent success rates demonstrate that PTD is safe and effective, and it is appropriate for first choice in the treatment algorithm of perihilar stenosis. Ultimately, we concluded that PTD should be performed in experienced centers to achieve low mortality, morbidity, and high success rates.

Kết quả sớm dẫn lưu mật xuyên gan qua da trong điều trị viêm đường mật cấp ở người cao tuổi

“…Tỉ lệ thành công Tỉ lệ thành công là 88,7%. Tỉ lệ thành công của các nghiên cứu trong và ngoài nước đạt tỉ lệ cao, từ 90 -99% [14], [15], [16], [17]. Tỉ lệ thành công của chúng tôi hơi thấp hơn.…”

“…Tỉ lệ thành công sau phẫu thuật theo nhiều nghiên cứu khoảng 90% [14], [15], [16], [17]. Như vậy ta có Z = 1,96 p = 0,9 d = 0,07 Tính được n = 70,56.…”

Predictive Factors for Symptomatic Dislodgement of Percutaneous Transhepatic Biliary Drainage Catheter in Patients with Malignant Biliary Obstruction

“…Curative resection is the best treatment; however, the diagnosis is often made at an advanced unresectable stage when palliative decompression remains the only option ( 7 ). PTBD is a well-established procedure with proven efficacy and relative safety for malignant biliary obstruction ( 8 9 10 ). However, PTBD is associated with various complications in 3%–10% of patients, ranging from puncture site pain to life-threatening conditions, including access-related, nonvascular, vascular or bleeding, catheter-related, and stent-related complications ( 11 ).…”