PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE – THE FIRST STEP IN THE TREATMENT OF MALIGNANT BILIARY OBSTRUCTION

Abstract

Introduction. Percutaneous transhepatic biliary drai­nage (PTBD) comes as safe and effective alternative when endoscopic biliary decompression is unavaila­ble. However, PTBD as invasive procedure has its own risks and complications. Our aim was to evaluate the clinical outcomes and possible benefits of an ul­trasound guided percutaneous transhepatic biliary drainage as the first step in the palliative treatment of malignant biliary obstruction. Methods. Retrospective review of patients undergoing percutaneous transhepatic biliary drainage from Ja­nuary 2014 to December 2015 at the Department of Surgery, Hospital of the Lithuanian University of He­alth Sciences was performed. Patients were reviewed for demographic data, laboratory tests, complications, outcomes, hospital stay and mortality rate. Results. During the study period ninety nine patients (median age - 68 years, (44 - 95) received 124 biliary drainage procedures for malignant obstructive jaun­dice. Prior the percutaneous drainage fifty eight pa­tients (58.6%) were unsuccessfully treated by ERCP. Forty patients (40.4%) were diagnosed with periam­pullary tumours, thirty (30.3%) had proximal/hi­lar cholangiocarcinoma, and twenty nine (29.3%) had biliary obstruction due to metastatic disease. Acute cholangitis was present in fifty two (52.5%) patients. After drainage procedure total serum bi­lirubin decreased in eighty seven (87.9%) patients (from 293.72±131.9 μmol to 193.11±117.49 μmol, p<0.05). Reduction in Gammaglutamyl transferase and Alkaline phosphatase was observed in ninety four (94.9%) patients. Seventy patients (70.7%) underwent additional interval procedures. In 62 (88.6%) cases percutaneous transhepatic biliary stenting was per­formed. The mean hospital stay was 25.5±17.9 days (after percutaneous drainage - 19.9±17.3 days). Thirty four (34.3%) patients developed drainage related mor­bidity, with drainage catheter dislocation being most common (76.5% (n = 26). In hospital mortality rate was 27.3% (n = 27) with one drainage related death (procedure related mortality rate - 3.7%). Conclusions. Percutaneous transhepatic biliary drai­nage is relatively safe and effective method to reduce malignant obstructive jaundice, when other, less inva­sive drainage methods are unavailable or ineffective and acts as a necessary step in further palliative tre­atment.