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Nennstiel, Simon, Matthias Treiber, Alexander Faber, Bernhard Haller, Stefan von Delius, Roland M. Schmid, and Bruno Neu. "Comparison of Ultrasound and Fluoroscopically Guided Percutaneous Transhepatic Biliary Drainage." Digestive Diseases 37, no. 1 (September 25, 2018): 77–86. http://dx.doi.org/10.1159/000493120.
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Background: Percutaneous transhepatic biliary drainage (PTBD) plays a significant role especially in the palliation of an endoscopically inaccessible biliary system. Since a standard technique of PTBD is not defined, we compared a fluoroscopically guided technique (F-PTBD) with an ultrasound (US-PTBD) guided approach. Patients and Methods: Procedure characteristics, success-rates and complication-rates of the different PTBD techniques were compared in patients who underwent PTBD between October 1, 2006, and December 31, 2014. Results: In 195 patients, 251 PTBDs (207 F-PTBDs, 44 US-PTBDs) were performed. F-PTBDs were mostly inserted from the right and US-PTBDs from the left. Patient age, gender and physical status were comparable in both techniques. There was no difference regarding overall procedure success (90%/86.4%), overall interventional complication rates (10.6%/9.1%), fluoroscopy times, intervention times or sedatives dosages. However, major complications were only encountered in F-PTBDs. There was a higher success rate for F-PTBD vs. US-PTBD from the right side (91.9 vs. 75%; p = 0.033) and a trend towards a higher success rate for US guidance from the left side (82.9 vs. 95.8%; p = 0.223). Conclusions: For drainage of the right biliary system F-PTBD seems superior over the US-PTBD technique used in this study. However, major complications can occur more frequently in F-PTBD.
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Paik, Woo, Nah Lee, Yousuke Nakai, Hiroyuki Isayama, Dongwook Oh, Tae Song, Sang Lee, et al. "Conversion of external percutaneous transhepatic biliary drainage to endoscopic ultrasound-guided hepaticogastrostomy after failed standard internal stenting for malignant biliary obstruction." Endoscopy 49, no. 06 (February 14, 2017): 544–48. http://dx.doi.org/10.1055/s-0043-102388.
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Abstract Background and study aim Percutaneous transhepatic biliary drainage (PTBD) is a rescue procedure after a failed endoscopic retrograde cholangiopancreatography. As PTBD causes patient discomfort, conversion of the PTBD to internal biliary stenting (PTBDS) may be required; however, PTBDS is sometimes difficult because of the tight stricture. We evaluated the efficacy and safety of conversion of external PTBD to endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) after failed PTBDS. Patients and methods A total of 16 patients with malignant distal biliary obstruction who underwent conversion of external PTBD to EUS-HGS after failed PTBDS were enrolled from two institutions in Korea and Japan. Data were analyzed retrospectively. Results The technical and clinical success rates were 100 % and 81 %, respectively. Early adverse events developed in two patients: proximal stent migration (n = 1), and cholecystitis (n = 1). Stents were occluded or migrated distally in five patients. The mean duration of stent patency was 402 days. Conclusions Conversion of external PTBD to EUS-HGS may be a good rescue option after failed PTBDS.
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Schmitz, Daniel, Niels Weller, Matthias Doll, Simon Weingärtner, Nuria Pelaez, Gabriele Reinmuth, Svetlana Hetjens, and Jochen Rudi. "An Improved Method of Percutaneous Transhepatic Biliary Drainage Combining Ultrasound-Guided Bile Duct Puncture with Metal Stent Implantation by Fluoroscopic Guidance and Endoscopic Visualization as a One-Step Procedure: A Retrospective Cohort Study." Journal of Clinical Interventional Radiology ISVIR 02, no. 03 (November 27, 2018): 135–43. http://dx.doi.org/10.1055/s-0038-1675883.
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Abstract Aims In recently published comparative studies, it is reported that percutaneous transhepatic biliary drainage (PTBD) is less successful, causes more adverse events, and needs more re-interventions than endoscopic ultrasound-guided biliary drainage (EUS-BD) in patients with malignant extrahepatic bile duct obstruction when endoscopic retrograde cholangiopancreatography (ERCP) fails. Could an improved technique of PTBD produce better results to use this technique for further comparative studies with EUSBD? Methods In our tertiary referral hospital, 116 prospectively documented, and retrospectively analyzed PTBDs with ultrasound guided ductal puncture were performed. In 16 of 30 PTBDs with metal stent implantation in malignant diseases, metal stent was inserted as a one-step procedure by endoscopic luminal guidance in the first session. Results Fifteen of 16 (94%) or 14/16 (88%) of PTBDs with primary metal stent implantation were technically or clinically successful. Mainly the left liver was used as access route for PTBD. Procedure time was 68.1 minutes (25–118), fluoroscopic time: 18.6 minutes (3–46), and patient radiation exposure: 5957 μGy/m2 (471–17,569). In 2/16 (12.5%) patients, adverse events (1 × mild and 1 × moderate grade of severity) were documented. One re-intervention was necessary (0.1/patient) in the observation time of 6 months. The mean overall survival time was 163.2 (7–864) days after PTBD. Conclusions PTBD with ultrasound-guided ductal puncture and primary metal implantation by endoscopic luminal guidance in patients with malignant extrahepatic bile duct obstruction showed good technical and clinical success and low adverse event and reintervention rates in our retrospective cohort study. Clinical Trial Registration: ClinicalTrials.gov ID: NCT03541590.
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Rees, James, Jemma Mytton, Felicity Evison, Kamarjit Singh Mangat, Prashant Patel, and Nigel Trudgill. "The outcomes of biliary drainage by percutaneous transhepatic cholangiography for the palliation of malignant biliary obstruction in England between 2001 and 2014: a retrospective cohort study." BMJ Open 10, no. 1 (January 2020): e033576. http://dx.doi.org/10.1136/bmjopen-2019-033576.
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IntroductionRelieving obstructive jaundice in inoperable pancreato-biliary cancers improves quality of life and permits chemotherapy. Percutaneous transhepatic cholangiography with drainage and/or stenting relieves jaundice but can be associated with significant morbidity and mortality. Percutaneous transhepatic biliary drainage (PTBD) in malignant biliary obstruction was therefore examined in a national cohort to establish risk factors for poor outcomes.MethodsRetrospective study of adult patients undergoing PTBD for palliation of pancreato-biliary cancer in England between 2001 and 2014 identified from Hospital Episode Statistics. Multivariate logistic regression analysis was used to examine associations with mortality and the need for a repeat PTBD within 2 months.Results16 822 patients analysed (median age 72 (range 19–104) years, 50.3% men). 58% pancreatic and 30% biliary tract cancer. In-hospital and 30-day mortality were 15.3% (95% CI 14.7% to 15.9%) and 23.1% (22.4%–23.8%), respectively. 20.2% suffered a coded complication within 3 months. Factors associated with 30-day mortality: age (≥81 years OR 2.68 (95% CI 2.37 to 3.03), p<0.001), increasing comorbidity (Charlson score 20+, 3.10 (2.64–3.65), p<0.001), pre-existing renal dysfunction (2.37 (2.12–2.65), p<0.001) and non-pancreatic cancer (unspecified biliary tract 1.28 (1.08–1.52), p=0.004). Women had lower mortality (0.91 (0.84–0.98), p=0.011), as did patients undergoing PTBD in a ‘higher volume’ provider (84–180 PTBDs per year 0.68 (0.58–0.79), p<0.001).ConclusionsIn patients undergoing PTBD for the palliation of malignant biliary obstruction, 30-day mortality was high at 23.1%. Mortality was higher in older patients, men, those with increasing comorbidity, a cancer site other than pancreas and at ‘lower-volume’ PTBD providers.
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Kim, Ki-Han, Ho-Byoung Lee, Sung-Heun Kim, Min-Chan Kim, and Ghap-Joong Jung. "Role of Percutaneous Transhepatic Biliary Drainage in Patients With Complications After Gastrectomy." International Surgery 101, no. 1-2 (January 1, 2016): 78–83. http://dx.doi.org/10.9738/intsurg-d-15-00117.1.
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The aim of this study was to elucidate the role of percutaneous transhepatic biliary drainage (PTBD) in patients with duodenal stump leakage (DSL) and afference loop syndrome (ALS) postgastrectomy for malignancy or benign ulcer perforation. Percutaneous transhepatic biliary drainage (PTBD) is an interventional radiologic procedure used to promote bile drainage. Duodenal stump leakage (DSL) and afferent loop syndrome (ALS) can be serious complications after gastrectomy. From January 2002 through December 2014, we retrospectively reviewed 19 patients who underwent PTBD secondary to DSL and ALS postgastrectomy. In this study, a PTBD tube was placed in the proximal duodenum near the stump or distal duodenum in order to decompress and drain bile and pancreatic fluids. Nine patients with DSL and 10 patients with ALS underwent PTBD. The mean hospital stay was 34.3 days (range, 12 to 71) in DSL group and 16.4 days (range, 6 to 48) in ALS group after PTBD. A liquid or soft diet was started within 2.6 days (range, 1 to 7) in the ALS group and within 3.4 days (range, 0 to 15) in the DSL group after PTBD. One patient with DSL had PTBD changed, and 2 patients with ALS underwent additional surgical interventions after PTBD. The PTBD procedure, during which the tube was inserted into the duodenum, was well-suited for decompression of the duodenum as well as for drainage of bile and pancreatic fluids. This procedure can be an alternative treatment for cases of DSL and ALS postgastrectomy.
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Angulo, Jenniffer, Carlos Joaquín Cáceres, Nataly Contreras, Leandro Fernández-García, Nathalie Chamond, Melissa Ameur, Bruno Sargueil, and Marcelo López-Lastra. "Polypyrimidine-Tract-Binding Protein Isoforms Differentially Regulate the Hepatitis C Virus Internal Ribosome Entry Site." Viruses 15, no. 1 (December 20, 2022): 8. http://dx.doi.org/10.3390/v15010008.
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Translation initiation of the hepatitis C virus (HCV) mRNA depends on an internal ribosome entry site (IRES) that encompasses most of the 5′UTR and includes nucleotides of the core coding region. This study shows that the polypyrimidine-tract-binding protein (PTB), an RNA-binding protein with four RNA recognition motifs (RRMs), binds to the HCV 5′UTR, stimulating its IRES activity. There are three isoforms of PTB: PTB1, PTB2, and PTB4. Our results show that PTB1 and PTB4, but not PTB2, stimulate HCV IRES activity in HuH-7 and HEK293T cells. In HuH-7 cells, PTB1 promotes HCV IRES-mediated initiation more strongly than PTB4. Mutations in PTB1, PTB4, RRM1/RRM2, or RRM3/RRM4, which disrupt the RRM’s ability to bind RNA, abrogated the protein’s capacity to stimulate HCV IRES activity in HuH-7 cells. In HEK293T cells, PTB1 and PTB4 stimulate HCV IRES activity to similar levels. In HEK293T cells, mutations in RRM1/RRM2 did not impact PTB1′s ability to promote HCV IRES activity; and mutations in PTB1 RRM3/RRM4 domains reduced, but did not abolish, the protein’s capacity to stimulate HCV IRES activity. In HEK293T cells, mutations in PTB4 RRM1/RRM2 abrogated the protein’s ability to promote HCV IRES activity, and mutations in RRM3/RRM4 have no impact on PTB4 ability to enhance HCV IRES activity. Therefore, PTB1 and PTB4 differentially stimulate the IRES activity in a cell type-specific manner. We conclude that PTB1 and PTB4, but not PTB2, act as IRES transacting factors of the HCV IRES.
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Kim, Min Uk, Yoontaek Lee, Jae Hwan Lee, Soo Buem Cho, Myoung Seok Lee, Young Ho So, and Young Ho Choi. "Predictive factors affecting percutaneous drainage duration in the percutaneous treatment of common bile duct stones." PLOS ONE 16, no. 3 (March 2, 2021): e0248003. http://dx.doi.org/10.1371/journal.pone.0248003.
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The duration of percutaneous transhepatic biliary drainage (PTBD) is a critical factor that determines the duration of treatment. This study aimed to evaluate factors affecting the PTBD duration in patients who underwent percutaneous treatment of common bile duct (CBD) stones. This study analyzed data of 169 patients who underwent percutaneous treatment of CBD stones from June 2009 to June 2019. Demographic data, characteristics of stone, procedure-related factors, and laboratory findings before the insertion of PTBD tubes were retrospectively evaluated. To assess the effect of confounding factors on the PTBD duration, multivariate linear regression analysis was applied, incorporating significant predictive factors identified in the univariate regression analysis. In the univariate regression analysis, the predictive factor that showed high correlation with the PTBD duration was the initial total bilirubin level (coefficient = 0.68, P < .001) followed by the short diameter of the largest stone (coefficient = 0.19, P = .056), and previous endoscopic sphincterotomy (coefficient = -2.50, P = .086). The multivariate linear regression analysis showed that the initial total bilirubin level (coefficient = 0.50, P < .001) and short diameter of the largest stone (coefficient = 0.16, P = .025) were significantly related to the PTBD duration. The total bilirubin level before PTBD tube insertion and the short diameter of the largest CBD stone were predictive factors for the PTBD duration in patients who underwent percutaneous CBD stone removal. Careful assessment of these factors might help in predicting the treatment period, thereby improving the quality of patient care.
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Lesmana, C. Rinaldi A., Rino A. Gani, Irsan Hasan, Andri Sanityoso Sulaiman, Khek Yu Ho, Vinay Dhir, and Laurentius A. Lesmana. "Palliative Endoscopic Ultrasound Biliary Drainage for Advanced Malignant Biliary Obstruction: Should It Replace the Percutaneous Approach?" Case Reports in Gastroenterology 13, no. 3 (September 25, 2019): 385–97. http://dx.doi.org/10.1159/000502835.
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Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) are the standard of care in malignant biliary obstruction cases. Recently, endoscopic ultrasound-guided biliary drainage (EUS-BD) has been widely used after unsuccessful ERCP. However, the patient’s clinical impact of EUS-BD over PTBD is still not obvious. Therefore, this case series study aims to evaluate the clinical outcomes of patients with advanced malignant biliary obstruction who underwent EUS-BD after failed ERCP. A retrospective database study was performed between January 2016 and June 2018 in patients with advanced malignant biliary obstruction. Patients were consecutively enrolled without randomization. Treatment options consisted of ERCP and PTBD or EUS-BD if ERCP failed. Based on 144 biliary obstruction cases, 38 patients were enrolled; 24 (63.2%) were men. The patients’ mean age was 66.8 ± 12.36 years. The most common cause of malignant biliary obstruction was pancreatic cancer (44.7%). Biliary drainage was achieved by ERCP (39.5%), PTBD (39.5%), and EUS-BD (21.1%). The technical success rate was 86.7% by PTBD and 87.5% by EUS-BD (p = 1.000), while the clinical success rate was 93.3% by PTBD and 62.5% by EUS-BD (p = 0.500). The median survival in patients who underwent PTBD versus those wo underwent EUS-BD was 11 versus 3 months (log-rank p = 0.455). In conclusion, there is no significant advantage of EUS-BD when compared to PTBD in terms of clinical success and survival benefit in advanced malignant biliary obstruction.
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Back, Sung Hoon, Yoon Ki Kim, Woo Jae Kim, Sungchan Cho, Hoe Rang Oh, Jung-Eun Kim, and Sung Key Jang. "Translation of Polioviral mRNA Is Inhibited by Cleavage of Polypyrimidine Tract-Binding Proteins Executed by Polioviral 3Cpro." Journal of Virology 76, no. 5 (March 1, 2002): 2529–42. http://dx.doi.org/10.1128/jvi.76.5.2529-2542.2002.
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ABSTRACT The translation of polioviral mRNA occurs through an internal ribosomal entry site (IRES). Several RNA-binding proteins, such as polypyrimidine tract-binding protein (PTB) and poly(rC)-binding protein (PCBP), are required for the poliovirus IRES-dependent translation. Here we report that a poliovirus protein, 3Cpro (and/or 3CDpro), cleaves PTB isoforms (PTB1, PTB2, and PTB4). Three 3Cpro target sites (one major target site and two minor target sites) exist in PTBs. PTB fragments generated by poliovirus infection are redistributed to the cytoplasm from the nucleus, where most of the intact PTBs are localized. Moreover, these PTB fragments inhibit polioviral IRES-dependent translation in a cell-based assay system. We speculate that the proteolytic cleavage of PTBs may contribute to the molecular switching from translation to replication of polioviral RNA.
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Sportes, Adrien, Marine Camus, Michel Greget, Sarah Leblanc, Romain Coriat, Jürgen Hochberger, Stanislas Chaussade, Sophie Grabar, and Frédéric Prat. "Endoscopic ultrasound-guided hepaticogastrostomy versus percutaneous transhepatic drainage for malignant biliary obstruction after failed endoscopic retrograde cholangiopancreatography: a retrospective expertise-based study from two centers." Therapeutic Advances in Gastroenterology 10, no. 6 (April 10, 2017): 483–93. http://dx.doi.org/10.1177/1756283x17702096.
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Background: Percutaneous transhepatic biliary drainage (PTBD) is widely performed as a salvage procedure in patients with unresectable malignant obstruction of the common bile duct (CBD) after failed endoscopic retrograde cholangiopancreatography (ERCP) or in case of surgically altered anatomy. Endoscopic ultrasound-guided hepaticogastrostomy (EU-HGS) is a more recently introduced alternative to relieve malignant obstructive jaundice. The aim of this prospective observational study was to compare the outcome, efficacy and adverse events of EU-HGS and PTBD. Methods: From April 2012 to August 2015, consecutive patients with malignant CBD obstruction who underwent EU-HGS or PTBD in two tertiary-care referral centers were included. The primary endpoint was the clinical success rate. Secondary endpoints were technical success, overall survival, procedure-related adverse events, incidence of adverse events, and reintervention rate. Results: A total of 51 patients (EU-HGS, n = 31; PTBD, n = 20) were included. Median survival was 71 days (range 25–75th percentile; 30–95) for the EU-HGS group and 78 days (range 25–75th percentile; 42–108) for the PTBD group ( p = 0.99). Technical success was achieved in all patients in both groups. Clinical success was achieved in 25 (86%) of 31 patients in the EU-HGS group and in 15 (83%) of 20 patients in the PTBD group ( p = 0.88). There was no difference in adverse events rates between the two groups (EU-HGS: 16%; PTBD: 10%) ( p = 0.69). Four deaths within 1 month (two hemorrhagic and two septic) were considered procedure related (two in the EU-HGS group and two in the PTBD group). Overall reintervention rate was significantly lower after EU-HGS ( n = 2) than after PTBD ( n = 21) ( p = 0.0001). Length of hospital stay was shorter after EU-HGS (8 days versus 15 days; p = 0.002). Conclusions: EU-HGS can be an effective and safe mini invasive-procedure alternative to PTBD, with similar success and adverse-event rates, but with lower rates of reintervention and length of hospitalization.
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Moole, Harsha, Sirish Dharmapuri, Abhiram Duvvuri, Sowmya Dharmapuri, Raghuveer Boddireddy, Vishnu Moole, Prathyusha Yedama, Naveen Bondalapati, Achuta Uppu, and Charan Yerasi. "Endoscopic versus Percutaneous Biliary Drainage in Palliation of Advanced Malignant Hilar Obstruction: A Meta-Analysis and Systematic Review." Canadian Journal of Gastroenterology and Hepatology 2016 (2016): 1–8. http://dx.doi.org/10.1155/2016/4726078.
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Background. Palliation in advanced unresectable hilar malignancies can be achieved by endoscopic (EBD) or percutaneous transhepatic biliary drainage (PTBD). It is unclear if one approach is superior to the other in this group of patients.Aims. Compare clinical outcomes of EBD versus PTBD.Methods.(i) Study Selection Criterion. Studies using PTBD and EBD for palliation of advanced unresectable hilar malignancies.(ii) Data Collection and Extraction. Articles were searched in Medline, PubMed, and Ovid journals.(iii) Statistical Method. Fixed and random effects models were used to calculate the pooled proportions.Results. Initial search identified 786 reference articles, in which 62 articles were selected and reviewed. Data was extracted from nine studies (N=546) that met the inclusion criterion. The pooled odds ratio for successful biliary drainage in PTBD versus EBD was 2.53 (95% CI = 1.57 to 4.08). Odds ratio for overall adverse effects in PTBD versus EBD groups was 0.81 (95% CI = 0.52 to 1.26). Odds ratio for 30-day mortality rate in PTBD group versus EBD group was 0.84 (95% CI = 0.37 to 1.91).Conclusions. In patients with advanced unresectable hilar malignancies, palliation with PTBD seems to be superior to EBD. PTBD is comparable to EBD in regard to overall adverse effects and 30-day mortality.
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Walter, Thomas, Chia Ho, Anne M. Horgan, Andrew Warkentin, Steven Gallinger, Rob Beecroft, David W. Hedley, Kongten Tan, Paul Kortan, and Jennifer J. Knox. "Endoscopic or percutaneous biliary drainage for Klatskin tumors? A large retrospective study." Journal of Clinical Oncology 30, no. 4_suppl (February 1, 2012): 277. http://dx.doi.org/10.1200/jco.2012.30.4_suppl.277.
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277 Background: Controversy exists over the preferred technique of biliary drainage in patients with Klatskin tumors as few comparative studies exist. This study compared outcomes of endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD). Methods: 129 patients with Klatskin tumors with an initial EBD or PTBD were identified from 01/01/1991 to 31/05/2011 and their clinical histories were retrospectively reviewed. The primary end point was the time to therapeutic success (TTS: time between the first drainage and a total bilirubin<40µmol/L), estimated by Kaplan-Meier analysis. Results: The first biliary decompression procedure was EBD in 87 patients and PTBD in 42 patients. The technical (98% vs 78%, p=0.004) and therapeutic (79% vs 49%, p=0.002) successes were significantly higher in the PTBD group than EBD group, respectively; Forty four patients (51%) in the EBD group subsequently underwent a PTBD before achieving therapeutic success or starting their antitumoral treatment. The median TTS was 55 days in EBD group vs 44 days in the PTBD group (multivariate analysis: HR=0.63, 95% CI=0.41-0.99, p=0.045). In patients treated by surgery or chemotherapy +/− radiotherapy, the median time to treatment was 68 and 76 days in the PTBD group and the EBD group, respectively, p=0.76. 25% and 21% of cholangitis occurred in EBD and PTBD group, respectively (p=0.34). Conclusions: In the era where chemotherapy prolongs life even in advanced disease, shortening time to success matters. Our results suggest relying on PTB for biliary decompression would be an improved treatment strategy when treating patients with Klatskin tumor.
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Park, Sung Eun, In Chul Nam, Hye Jin Baek, Kyeong Hwa Ryu, Sung Gong Lim, Jung Ho Won, and Doo Ri Kim. "Effectiveness of ultrasound-guided percutaneous transhepatic biliary drainage to reduce radiation exposure: A single-center experience." PLOS ONE 17, no. 11 (November 4, 2022): e0277272. http://dx.doi.org/10.1371/journal.pone.0277272.
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Percutaneous transhepatic biliary drainage (PTBD) has been an effective treatment to access the biliary tree, especially in case of endoscopically inaccessible biliary tree. In general, PTBD techniques are divided into two methods: fluoroscopy-guided PTBD and ultrasound (US)-guided PTBD. This study aimed to evaluate the effectiveness of US-guided PTBD, focusing on radiation exposure according to intrahepatic duct (IHD) dilatation degree, differences between right- and left-sided approaches and differences between benign and malignant biliary stenosis/obstruction. We evaluated technical success, clinical success, procedural data (the number of liver capsule punctures, procedural time, fluoroscopy time and radiation dose), and procedure-related complications. During the study period, a total of 123 patients with biliary stenosis/obstruction or bile leakage were initially eligible. We excluded 76 patients treated with only ERCP or initially treated with ERCP followed underwent PTBD insertion. Finally, a total of 50 procedures were performed in 47 patients. Of the 47 patients, 8 patients had anatomical alteration due to previous surgery, 6 patients refused ERCP, and 3 patients failed ERCP. For the remaining 30 patients, PTBD was performed on weekend or at night, 11 of whom had poor general condition, 10 patients underwent ERCP 3 to 4 days later after PTBD insertion, 6 patients improved after PTBD insertion without ERCP, 1 patient died, and 1 patient was referred to other hospital. Remaining 1 patient underwent surgery due to Mirizzi syndrome. All procedures were performed by two interventional radiologists. Technical success rate was 100%, clinical success was 94%, and the complication rate was 10%. Fluoroscopy time and the reported radiation dose were significantly lower in patients with dilated bile ducts than in those with non-dilated bile ducts, when biliary puncture under US guidance was performed initially. However, even in patients with non-dilated bile ducts undergoing initial trials of biliary puncture under US guidance, the fluoroscopy time and the reported radiation dose were low, based on current studies. No statistical significant differences were observed in terms of technical and dosimetry results according to right-sided and left-sided procedures and benign and malignant biliary stenosis/obstruction. Thus, US-guided PTBD was found to be a safe and effective technique that significantly reduced fluoroscopy time and radiation doses.
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Crosara, Marcela Alves Teixeira, Milena P. Mak, Daniel Fernandes Marques, Fernanda C. Capareli-Azevedo, and Paulo Marcelo Hoff. "Percutaneous transhepatic biliary drainage (PTBD) in patients (pts) with advanced solid malignancies: Clinical outcomes and prognostic factors." Journal of Clinical Oncology 30, no. 4_suppl (February 1, 2012): 315. http://dx.doi.org/10.1200/jco.2012.30.4_suppl.315.
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315 Background: Obstructive jaundice (OJ) is a cumbersome complication in pts with advanced digestive malignancies, and PTBD is often used to relieve symptoms and allow chemotherapy (CT) administration. Methods: From July 2008 to August 2011, a total of 71 pts with OJ due to advanced solid malignancies underwent PTBD in our institution. Baseline characteristics, procedure complications and outcome were retrospectively collected. The primary goal was to estimate overall survival (OS) after PTBD. Results: Patients’ median age was 60 years old, 52% were male, 72% had an ECOG performance status (PS) of 1-2 and 10% were in supportive care (SC). Most had metastatic disease at diagnosis (59.2%) and primary gastrointestinal tumors (biliary tract 42.3%, gastric 18.3%, colorectal 11.3%, pancreas 16.9% and 11.3% other sites). Mean hospital stay was 16.6 days (2-90), with bilirubin value decreased (BVD) in 80% of pts. The rate of cholangitis following PTBD was 66.2% and 60.6% of pts had readmissions related to procedure complications. Only 51.6% of pts not in SC were eligible for CT after PTBD. Median OS was 2.9 months (95% CI: 0.62-5.2). Prognostic factors on univariate analysis were ECOG ≤2 (13 versus 0.72 months p<0.0001); BVD (6.7 versus 0.33 months p<0.0001); CT after PTBD (13.7 versus 1.2 months p<0.0001). SC was a negative prognostic factor (0.8 versus 4.5 months p<0.0001). On the multivariate analysis, palliative CT after procedure was related to better OS (HR 0,16 CI: 0.05-0.48 p<0.001). Conclusions: Malignant OJ is a late, and often final event in cancer pts. Thorough evaluation is needed before determining pts eligibility to PTBD, due to its high complication and hospitalization rates. In the current analysis, pts with PS >2 and who are not candidates for further CT had a dismal prognosis, and should probably not be offered PTBD.
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Bapat, R. D., N. N. Rege, R. S. Koti, N. K. Desai, and S. A. Dahanukar. "Can We Do Away With PTBD?" HPB Surgery 9, no. 1 (January 1, 1995): 5–11. http://dx.doi.org/10.1155/1995/90362.
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Percutaneous Transhepatic Biliary Drainage (PTBD) is performed in surgical jaundice to decompress the biliary tree and improve hepatic functions. However, the risk of sepsis is high in these patients due to immunosuppression and surgical outcome remains poor. This raises a question—can we do away with PTBD? To answer this query a study was carried out in 4 groups of patients bearing in mind the high incidence of sepsis and our earlier studies, which have demonstrated immunotherapeutic potential of Tinospora cordifolia (TC): (A) those undergoing surgery without PTBD (n = 14), (B) those undergoing surgery after PTBD (n = 13). The mortality was 57.14% in Group A as compared to 61.54% in Group B. Serial estimations of bilirubin levels carried out during the course of drainage (3 Wks) revealed a gradual and significant decrease from 12.52 ± 8.3 mg% to 5.85 ± 3.0 mg%. Antipyrine half-life did not change significantly (18.35 ± 4.2 hrs compared to basal values 21.96 ± 3.78 hrs). The phagocytic and intracellular killing (ICK) capacities of PMN remained suppressed (Basal: 22.13 ± 3.68% phago, and 19.1 ± 4.49% ICK; Post drainage: 20 ± 8.48% Phago and 11.15 ± 3.05% ICK). Thus PTBD did not improve the metabolic capacity ofthe liver and mortality was higher due to sepsis. Group (C) patientg received TC during PTBD (n = 16) and Group (D) patients received TC without PTBD (n = 14). A significant improvement in PMN functions occurred by 3 weeks in both groups (30.29 ± 4.68% phago, 30 ± 4.84% ICK in Group C and 30.4 ± 2.99% phago, 27.15 ± 6.19% ICK in Group D). The mortality in Groups C and D was 25% and 14.2% respectively during the preoperative period. There was no mortality after surgery. It appears from this study that host defenses as reflected by PMN functions play an important role in influencing prognosis. Further decompression of the biliary tree by PTBD seems unwarranted.
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Rani, Khushboo, Kumar Gaurav, and Naveen Kumar. "PTBD During COVID-19 Pandemic: A Life Saving Procedure in Malignant Obstructive Jaundice Patients." Asian Pacific Journal of Cancer Care 6, S1 (June 6, 2021): 17–19. http://dx.doi.org/10.31557/apjcc.2021.6.s1.17-19.
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Objective: PTBD is an important lifesaving alternative for biliary tract decompression to endoscopic drainage in the treatment of malignant obstructive jaundice patients. The aim of this study was to evaluate the usefulness of PTBD in terms of the relief of symptoms and laboratory data, survival after PTBD, and the relationship between patient characteristics and survival during COVID-19 pandemic. Methods: During this study, in total thirteen patients’ procedures of percutaneous drainage were applied during a three-month period. The average age of men was 59 years and women was 55 years. The causes of obstructive jaundice were investigated using both abdominal computed tomography and abdominal ultrasonography. Results: In examined group percutaneous drainage was successful in 92.3% (12 patients) and drainage procedure application was ineffective in 7.7% (1 patient). After PTBD, almost all the symptoms of obstructive jaundice were relieved, except in one patient. Transient haemobilia was the only complication seen in one patient. Conclusion: In present scenario of COVID-19 pandemic, PTBD emerges as an effective method of biliary tract decompression and an important alternative to endoscopic drainage. It decreased the jaundice and relieved the symptoms caused by biliary tract obstruction. Thus, our study shows a positive impact in quality of life of patients after PTBD.
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Arfijanto, Muhammad Vitanata, and Bayu Abhiyoga. "Cholangiocarcinoma With Sepsis Associated With Percutaneous Transhepatic Biliary Drainage (PTBD)." Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy 22, no. 3 (January 5, 2022): 240–48. http://dx.doi.org/10.24871/2232021240-248.
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Percutaneous transhepatic biliary drainage (PTBD) can be an alternative palliative treatment in resectable cholangiocarcinoma. One of the most common complications of PTBD is infection, with a prevalence of 3.6 – 67.4% in patients undergoing PTBD procedure, with mortality rate of 0.05-7%. We report a case of a 46-year old male with a history of fever 14 days after undergoing PTBD procedure. Physical examination revealed tachycardia, tachypnea, febris, jaundice, and decreased urine output. Laboratory results revealed hypochromic-microcytic anemia, leukocytosis, decreased renal function, elevated liver enzymes, obstructive icterus, hypoalbuminemia, and hyperkalemia. Blood and gall culture revealed a growth of Eschericia coli. The patient was given fluid resuscitation and antibiotic suitable to microbial sensitivity test, and treatment of acute kidney injury and hyperkalemia, including hemodialysis. The patient’s general condition improved after ten days of care, and was discharged on the twentieth day. Cholangitis is one of the most infectious complications following PTBD procedure. The prevalence of sepsis in biliary drainage procedures was reported 2.5-2.7%, with enteral bacteria gram-negative bacilli being the most common pathogen found in blood and bile. The administration of prophylactic antibiotics was not proven to decrease prevalence of infection. Bacterial translocation via portal vein due to loss of mucosal integrity in the intestines may contribute to bacteremia following PTBD procedure.
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Sawant, Milind B., S. Harish, Nishant Lohia, S. Anand, Manoj Prashar, Sankalp Singh, and Gaurav Trivedi. "Retrospective analysis of the efficacy of percutaneous transhepatic biliary drainage in palliation of obstructive jaundice in patients with carcinoma gall bladder: Experience from tertiary care center in Northern India." Asian Journal of Medical Sciences 12, no. 11 (November 1, 2021): 98–103. http://dx.doi.org/10.3126/ajms.v12i11.38761.
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Background: Percutaneous Transhepatic Biliary Drainage (PTBD) is a minimally invasive procedure to palliate the biliary obstruction caused by unresectable malignancy. Aims and Objective: To analyze the outcome of PTBD in patients of unresectable gall bladder cancer presenting with obstructive jaundice in terms of reduction in serum bilirubin levels, symptomatic improvement, and overall survival (OS) at 4 weeks and 12 weeks following the procedure. Materials and Methods: In this retrospective study, PTBD was attempted on 30 patients diagnosed with inoperable gall bladder cancer. Various patient and procedure-related variables were analyzed and recorded both pre and post-PTBD. Outcome data on OS was collected at 4 weeks and 12 weeks. Results: Technical success was achieved in 29 (99.66%) patients. The mean fall in the serum bilirubin at the 7th post-procedural day was 41.5% after the successful PTBD. The most common complication in our study was cholangitis noted in six (21%) patients. OS at 4 weeks and 12 weeks was 79% and 41%, respectively. Conclusion: Younger age and good performance status favored better survival rate in our study.
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Nikolić, Ivan, Jelena Radić, Andrej Petreš, Aleksandar Djurić, Mladjan Protić, Jelena Litavski, Maja Popović, Ivana Kolarov-Bjelobrk, Saša Dragin, and Lazar Popović. "The Clinical Benefit of Percutaneous Transhepatic Biliary Drainage for Malignant Biliary Tract Obstruction." Cancers 14, no. 19 (September 26, 2022): 4673. http://dx.doi.org/10.3390/cancers14194673.
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Percutaneous transhepatic biliary drainage (PTBD) is a decompression procedure for malignant proximal biliary obstruction. In this research, over a six-year period, 89 patients underwent PTBD procedure for jaundice caused by malignant disease to restart chemotherapy or for palliative intent. Clinical outcomes after PTBD procedure in the two groups of patients, according to the adequate bilirubin decline (ABD) needed for subsequent chemotherapy, are presented in this paper. Survival and logistic regression were plotted and compared using Kaplan–Meier survival multivariate analysis with a long-range test. Results were processed by MEDCALC software. In the series, 58.4% (52/89) of patients were in good performance status (ECOG 0/1), and PTBD was performed with the intention to (re)start chemotherapy. The normalization of the bilirubin level was seen in 23.0% (12/52), but only 15.4% (8/52) received chemotherapy. The median survival time after PTBD was 9 weeks. In patients with ABD that received chemotherapy, the median survival time was 64 weeks, with 30-day mortality of 27.7%, and 6.4% of death within 7 days. The best outcome was in patients with good performance status (ECOG 0–1), low bilirubin (<120 µmol/L) and LDH (<300 µmol/L) levels and elevated leukocytes at the time of the procedures. PTBD is considered in ABD patients who are candidates for chemotherapy.
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Susak, Ya M., R. Ya Palitsa, L. Yu Markulan, and M. V. Maksуmenko. "Infection of the biliary tract during palliative drainage in patients with hilar malignant jaundice." EMERGENCY MEDICINE 17, no. 2 (May 24, 2021): 79–86. http://dx.doi.org/10.22141/2224-0586.17.2.2021.230653.
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Background. Hilar malignant biliary obstruction in about 80 % of patients is not subject to radical treatment. Percutaneous transhepatic biliary drainage (PTBD) eliminates jaundice syndrome but is associated with bile loss. External-internal drainage is intended to eliminate this disadvantage, however, the balance between its benefits and the risk of complications, in particular cholangitis, has not yet been determined. The aim was to compare the rate of cholangitis and survival after percutaneous transhepatic biliary drainage and external-internal suprapapillary drainage treatment in patients with hilar malignant jaundice. Materials and methods. Fifty patients with hilar malignant jaundice were prospectively examined. Patients who underwent percutaneous transhepatic biliary drainage were included in the PTBD group (n = 24); patients who underwent external-internal suprapapillary biliary drainage (EISBD) treatment were included in the EISBD group (n = 26). The endpoints of the study were the rate of cholangitis, cholangitis duration index (number of cholangitis-days per 100 patient-days in a group), and cumulative survival. Results. Cholangitis during the entire follow-up period occurred in 7 (14.0 %) patients: in 3 (11.5 %) patients in the EISBD group, in 4 (16.7 %) patients in the PTBD group; p = 0.602. Taking into account the census data (patients who died during this period), the difference in the cumulative frequency of cholangitis was more significant (25.6 % in the EISBD group, 49.1 % in the PTBD group); p = 0.142. The average time of the onset of cholangitis from the beginning of the operation was 68.8 ± 14.7 days in the PTBD group, 90.7 ± 42.0 days in the EISBD group; p = 0.601. In the EISBD group, the cholangitis duration index was less than in the PTBD group: 0.46 versus 1.4 cholangitis-days per 100 patient-days, respectively, p = 0.001. Patients of the EISBD group had a greater cumulative survival rate compared with the PTBD group: the median survival was 90 days (95% CI: 70.0–109.9 days) and 75 days (95% CI: 51.1–98.9 days), respectively; p = 0.033. Conclusions. For palliative management of hilar malignant jaundice, EISBD treatment should be the priority over PTBD treatment.
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Nikolic, Ivan, Andrej Petres, Viktorija Vucaj-Cirilovic, Nenad Solajic, and Jelena Radic. "Implantation metastasis of colorectal cancer following percutaneous biliary drainage." Srpski arhiv za celokupno lekarstvo, no. 00 (2022): 100. http://dx.doi.org/10.2298/sarh220819100n.
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Introduction. Malignant biliary obstruction represents a poor prognostic sign of metastatic colorectal carcinoma. Percutaneous transhepatic biliary drainage (PTBD) is the procedure of choice for palliative biliary decompression, and this method have both a diagnostic and therapeutic value. One of the well-known complications following this procedure is the development of catheter tract metastases that occur in up to 6% of cases post-PTBD. The aim was to present a patient with implantation metastases of colorectal cancer following PTBD. Case report. In the last six years, 89 patients underwent PTBD procedure at the Oncology Institute of Vojvodina. Among these patients, catheter tract implantation metastasis developed in one patient (1.1%). In this report, we present a patient who underwent right hemicolectomy in January 2015 at the Institute due to colon cancer located in the transverse colon. In January of 2018, a computed tomography scan of the abdomen showed metastatic disease and chemotherapy was initiated. However, 29 months following the start of chemotherapy, the patient developed jaundice, and as a result, PTBD procedure was performed. A control computed tomography scan of the abdomen in March of 2021 showed a de novo subcutaneous nodule 20 mm in diameter located at the level of ninth right rib. The nodule had been considered a part of the scar that formed at a place of catheter entry, and was still present eight months after PTBD procedure. Biopsy of the subcutaneous mass and pathohistological analysis confirmed well differentiated colon adenocarcinoma. Conclusion. Catheter tract implantation metastasis is not a rare complication following PTBD for malignant biliary obstruction. It generally has a poor prognosis. Nevertheless, literature review shows that radical surgical excision of the catheter tract tissue with hepatectomy can prolong survival in select group of patients.
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Ba, Yongjiang, Ping Yue, Joseph W. Leung, Haiping Wang, Yanyan Lin, Bing Bai, Xiaoliang Zhu, et al. "Percutaneous transhepatic biliary drainage may be the preferred preoperative drainage method in hilar cholangiocarcinoma." Endoscopy International Open 08, no. 02 (January 22, 2020): E203—E210. http://dx.doi.org/10.1055/a-0990-9114.
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Abstract Background and study aims Preoperative biliary drainage of hilar cholangiocarcinoma (HC) is controversial. The goal of this study was to compare the clinical outcome and associated complications for types II, III, and IV HC managed by percutaneous transhepatic biliary drainage (PTBD) and endoscopic retrograde cholangiopancreatography (ERCP). Patients and methods Between January 2011 and June 2017, a total of 180 patients with II, III, and IV HC were enrolled in this retrospective cohort study. According to the drainage method, patients were divided into two groups: PTBD (n = 81) and ERCP (n = 99). This study was registered with ClinicalTrials.gov, NCT03104582, and was completed. Results Compared with the PTBD group, the ERCP group had a higher incidence of post-procedural cholangitis (37 [37.37 %] vs. 18 [22.22 %], P = 0.028) and pancreatitis (17 [17.17 %] vs. 2 [2.47 %], P = 0.001); required more salvaged biliary drainage (18 [18.18 %] vs. 5 [6.17 %], P = 0.029), and incurred a higher cost (P < 0.05). Patients with type III and IV HC in the ERCP group had more cholangitis than those in the PTBD group (26 [36.62 %] vs. 11 [18.03 %], P = 0.018). The rate of cholangitis in patients who received endoscopic bilateral biliary stents insertion was higher than patients with unilateral stenting (23 [50.00 %] vs. 9 [26.47 %], P = 0.034), and underwent PTBD internal-external drainage had a higher incidence of cholangitis than those with only external drainage (11 [34.36 %] vs. 7 [14.29 %], P = 0.034). No significant difference in the rate of cholangitis was observed between the endoscopic unilateral stenting group and the endoscopic nasobiliary drainage group (9 [26.47 %] vs. 5 [26.32 %], P = 0.990). Conclusion Compared to ERCP, PTBD reduced the rate of cholangitis, pancreatitis, salvage biliary drainage, and decreased hospitalization costs in patients with types II, III, and IV HC. Risk of cholangitis for patients with types III and IV was significantly lower in the PTBD group.
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Juniawan, Radhitya Farizky Deta, Ummi Maimunah, Titong Sugihartono, Ulfa Kholili, Budi Widodo, Husin Thamrin, Muhammad Miftahussurur, and Amie Vidyani. "Complications of repeated percutaneous transhepatic biliary drainage (PTBD) for palliation of obstructive jaundice in cholangiocarcinoma patient." Bali Medical Journal 11, no. 2 (August 16, 2022): 850–55. http://dx.doi.org/10.15562/bmj.v11i2.3465.
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Background: Cholangiocarcinoma, a malignancy of the biliary duct system, has been recognized as the second most common cause of biliary tract and primary liver malignancies. The incidence has increased in the last three decades worldwide. Percutaneous transhepatic biliary drainage (PTBD) has been considered a highly important palliative therapy for bile duct obstruction due to its high success rate and low incidence of cholangitis. However, bleeding and catheter dislodgment are still found during the procedure. This case discusses the complications of repeated PTBD stent placement as palliative therapy in a patient with obstructive jaundice due to cholangiocarcinoma. Case Presentation: A 58-year-old female presented with a chief complaint of weakness and pain on the right side of the abdomen, particularly at the site of PTBD stent installation three days before being admitted to Dr. Soetomo General Hospital. In 2017, the patient was diagnosed with cholangiocarcinoma with obstructive jaundice and had undergone PTBD procedure five times during the period of July 2017 to March 2018 due to biliary leakages. Laboratory investigation indicated elevated bilirubin, decreased potassium, increased random blood sugar, increased blood urea nitrogen, high levels of the 2-hour postprandial blood glucose, and elevated HbA1c, suggesting the conditions of cholangiocarcinoma with obstructive jaundice complicated with hypokalemia, acute kidney injury and type-2 diabetes. The blood smear also indicated normochromic normocytic anisopoikilocytosis anemia and leukocytosis. The patient improved after PTBD replacement, antibiotics treatment, packed red cells transfusion, and rehydration therapy. Conclusion: This case highlights that the complication of PTBD could occur relatively frequently and to prevent the complications in patients with post-PTBD regular medical check-up is therefore recommended. In addition, it is also critical to improve the patient knowledge on how to prevent the bleeding and to avoid the conditions that are potentially increase the chance of catheter dislodgment.
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Mohammed, Naser Abdullah, Ahmed Al-Karbuli, Abdullah Saeed Ibrahim, and Muhsin Abubakir Mohammed. "Percutaneous Trans-Hepatic Biliary Drainage In Kurdistan Center For Gastroenterology And Hepatology." Advanced medical journal 1, no. 1 (August 26, 2015): 1–6. http://dx.doi.org/10.56056/amj.2015.01.
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Background and Objectives Percutaneous trans-hepatic biliary drainage (PTBD) is an invasive, effective therapeutic method of relieving benign or malignant biliary obstruction and lifesaving if the patient is septic. Moreover, PTBD is indicated in most of the conditions, when failed ERCP and/or ERCP not feasible. Our objective is to investigate the impact and effec tiviness of PTBD in the management of obstructive jaundice Patients and Methods A Prospective clinical study extended from February 2013- October 2013 and included 32 patients whom referred for PTBD to KCGH in Sulaimania city. All patients were meet inclusion criteria for PTBD. After the procedure all of them had follow up. Results Thirty-two patients (19 females and 13 male), with mean age 62.25 years were included, with the etiology of the obstructive jaundice being cholangiocarcinoma, pancreatic mass; porta hepatis lymph node, gallbladder carcinoma, and peri ampullary tumor were (44%, 31%, 9.5%, 9.5% and 6%) respectively. Metallic stent, external - internal catheter and dilatation were inserted in 65.5%, 31.5% and 3% respectively. Intra procedurally 90.6% had pain and post procedurally had pain, bleeding and cholangitis (64.5%, 3.2% and 3.2%) respectively. There was a significant difference between the pre, and post procedures of (ALT, AST, ALP, TSB, and Direct Bilirubin), with P value 0.001, 0.003, 0.001, 0.001, and 0.001 respectively. Conclusions PTBD is effective, and relatively safe, with the desirable outcome in the management of obstructive jaundice when other lines of treatment are not effective or possible
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Gupta, Pankaj, Jyoti Gupta, and Praveen Kumar-M. "Imaging in Obstructive Jaundice: What a Radiologist Needs to Know before Doing a Percutaneous Transhepatic Biliary Drainage." Journal of Clinical Interventional Radiology ISVIR 4, no. 01 (February 4, 2020): 31–37. http://dx.doi.org/10.1055/s-0039-3401327.
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AbstractPercutaneous transhepatic biliary drainage (PTBD) is one of the commonly performed biliary interventions. In patients with obstructive jaundice, PTBD may be a lifesaving emergency procedure or may serve as an alternative intervention in patients who fail to undergo endoscopic drainage or those who are too sick to be considered for endoscopic drainage. The key factor in technical and clinical success of PTBD is a thorough preprocedure imaging evaluation. In this review, we highlight the imaging aspects that should be evaluated and reported by a radiologist when evaluating a patient planned for biliary drainage.
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Sharma, Vishal, K. V. Raghavendra Prasada, Surinder S. Rana, A. C. Arun, Anupam Lal, Rajesh Gupta, and Deepak K. Bhasin. "A modification of rendezvous technique for endoscopically treating transected common bile duct following cholecystectomy." Journal of Digestive Endoscopy 05, no. 03 (July 2014): 129–31. http://dx.doi.org/10.4103/0976-5042.147503.
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AbstractEndoscopic therapy is the standard of care for management of most benign biliary strictures. However, endoscopic therapy can fail in very tight strictures. We report a case of a 52-year-old lady who had complete bile duct transection with stricture after laparoscopic cholecystectomy. In initial attempt, at endoscopic retrograde cholangiopancreatography (ERCP), guidewire could not be negotiated endoscopically across the narrowing as there was complete cut off of the bile duct and so a percutaneous transhepatic biliary drainage (PTBD) was done and subsequently internalized into the duodenum. We cannulated the internalized end of PTBD catheter with the standard ERCP cannula with guidewire and advanced it across the biliary stricture. PTBD catheter was withdrawn externally, and the guidewire was left in the left ductal system. We report this innovation as this may be helpful in managing patients with ERCP after an initial PTBD has been successfully internalized into the duodenum.
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Jain, Apurva, Juhee Song, Milind M. Javle, and Marina C. George. "Risk factors associated with recurrent cholangitis in pancreatic and hepatobiliary cancers." Journal of Clinical Oncology 35, no. 4_suppl (February 1, 2017): 428. http://dx.doi.org/10.1200/jco.2017.35.4_suppl.428.
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428 Background: Acute cholangitis due to malignant biliary obstruction is frequent in patients with pancreatic and hepatobiliary cancers. Recurrent cholangitis (RC) results in repeated hospitalization and delayed cancer care. The risk factors associated with RC are not yet defined. Methods: A pilot review was done on 146 patients admitted with a diagnosis of cholangitis from 2005 to 2014. We included demographics, cancer stage, details of first admission (FA) and interventions. Univariate and multivariate Fine-Gray models were used for statistical analysis. Results: The mean age at FA was 62 yrs, 84 (58%) were males and 99 (68%) were white. Most common cancer was pancreatic 100(69%) and 27(19%) pts had primary cholangitis at FA. During FA, interventions were performed in 114(78%), of whom 51 (45%) had percutaneous drainage (PTBD) and 63 (55%) had endoscopic drainage (ED). Readmission with cholangitis was noted in 35 (24%) cases. Univariate analysis did not show a difference between PTBD and ED. However, subgroup analysis showed external only PTBD and covered metallic stent ED had lower risk of RC. These variables remained significant on multivariate analysis (Subdistribution HR= 0.00, p<.0001 for both). Multiple previous PTBD (≥2) before FA was significantly associated with increased risk of RC (Subdistribution HR= 2.64, p= 0.01) on univariate analysis. Conclusions: Having multiple previous PTBD is associated with recurrent cholangitis. Though no significant difference was noted between PTBD and ED, the subgroups indicated a trend towards less recurrent cholangitis with covered metallic stent. [Table: see text]
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Mukund, Amar, Ashok Choudhury, Swati Das, Viniyendra Pamecha, and Shiv Kumar Sarin. "Salvage PTBD in post living donor liver transplant patients with biliary complications—a single centre retrospective study." British Journal of Radiology 93, no. 1108 (April 2020): 20191046. http://dx.doi.org/10.1259/bjr.20191046.
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Objective: To study the outcome of salvage percutaneous transhepatic biliary drainage (PTBD) in complex and technically challenging post-liver transplant (LT) biliary complications and analyse the reason for failure of endoscopic retrograde cholangiopancreatography (ERCP). Methods and materials: Hospital data were searched for all LT patients with biliary complications requiring salvage PTBD (upon failure of ERCP) from January 2010 to May 2017. Patients who underwent primary PTBD were excluded. Patients clinical and biochemical parameters were analysed for clinical, biochemical and imaging response, stent-free survival and the reason for ERCP failure. Results: Salvage PTBD was performed in 32 patients with post-LT biliary stricture/bile leak presenting with deranged liver function in 12 (37.5%), cholangitis in 12 (37.5%) and cholangitis with cholangitic abscess in remaining 8 (25%) patients. Of 32 patients, 20 (62.5%) already had plastic biliary stent placed by ERCP, while in remaining (n = 12, 37.5%) a wire could not be negotiated across stricture by ERCP. These patients were found to have long/tortuous stricture (n = 18, 56.3%) and multiple duct disconnection at anastomosis (n = 14, 43.7%). Immediate as well as sustained (persisting for a year or more) clinical and biochemical improvement was seen in 26 (81.3%) patients, while failure of resolution of sepsis and death occurred in remaining 6 (18.8%). Conclusion: Salvage PTBD is an effective treatment in difficult-to-treat post-LT biliary strictures with deranged liver functions with or without cholangitis/cholangitic abscess. It can reduce graft loss with improved clinical outcome. Post-LT ductal anatomy at anastomosis is important to decide the appropriate approach (ERCP/PTBD). Advances in knowledge: (1). PTBD as a salvage procedure in difficult anatomy or upon failure of ERCP-based intervention is effective and a good alternative strategy. (2). Postoperative surgical anatomy (type & length of stricture, number of ductanastomosis, location and graft-recipient duct alignment) is the key factor indeciding the appropriate therapeutic procedure.
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Rafiq, Suhail, Azhar Khan, Jan Suhail, Nasir Choh, and Feroze Shaheen. "Complications of left and right sided percutaneous transhepatic biliary drainage." International Journal of Advances in Medicine 6, no. 4 (July 24, 2019): 1281. http://dx.doi.org/10.18203/2349-3933.ijam20193286.
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Background: Percutaneous Transhepatic Biliary Drainage (PTBD) is performed either via right or left-ductal approach, on the basis of status of primary confluence, secondary confluence and atrophy of liver parenchyma. Our study compares the complications of two approaches in malignant obstruction. The objectives of this study was to assess and compare complications of PTBD.Methods: This study was a prospective hospital based study performed for a period of 2 years from 2016 to 2018.PTBD was performed either via right in 16 patients or left-ductal approach in 15 patients, on the basis of status of primary biliary confluence and atrophy of liver parenchyma.Results: Both minor and major complications were more common in right-sided approach as compared to left-sided approach with most common major and minor complication being cholangitis (16.12%) and fever (12.9%) respectively.Conclusions: PTBD is an excellent palliative procedure to drain the bile ducts in malignant obstruction. Although complications of PTBD are more common in right sided approach but results are statistically insignificant.
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Susak, Y. M. "THE IMPACT OF BILIARY DRAINAGE MODE ON BACTERIOBILIA OCCURRENCE IN PATIENTS WITH HILAR MALIGNANT OBSTRUCTION." Biotechnologia Acta 15, no. 4 (August 31, 2022): 44–46. http://dx.doi.org/10.15407/biotech15.04.044.
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The purpose of this study was comparative assessment of the frequency of bacterial colonization of the bile in patients with hilar malignant biliary obstruction after the palliative biliary decompression using different methodological approaches. Methods. 50 patients with proximal mechanical jaundice of tumor origin aged of ~ 62 years (25 males and 25 females), who were on steady-state treatment in Main military clinical hospital (Kyiv, Ukraine) were recruited in this prospective study. All patients underwent cholangiostomy using percutaneous transhepatic (PTBD) and external-internal suprapapillary (EISBD) approaches. Bile specimens were taken right after the biliary drainage. Identification of bacterial isolates was performed using standard cultural and biochemical methods. Results. The incidence of cholangitis was almost twice lower in EISBD group (n=26) than in PTBD group (n=24): 25.6% vs 49.1%. The rates of bacteriobilia did not differ significantly in patients from different groups: 23.1% in EISBD group and 25.0% in PTBD group. However, the frequency of biliary bacterial colonization coupled with cholangitis was also 2 times lower in EISBD group in comparison with patients underwent PTBD: 7.7% vs 16.7%. Escherichia coli predominated in bile specimens from patients with bacteriobilia associated with cholangitis in both groups. Conclusions. The use of EISBD for palliative biliary decompression in patients with proximal mechanical jaundice of tumor origin is associated with lower risk of bacterial colonization of the bile as compared to PTBD approach, and as a result with less risk of the development of infectious complications
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Audisio, Riccardo A., Carlo Morosi, Federico Bozzetti, Guido Cozzi, Massimo Bellomi, Paola Pisani, Alessandra Pestalozza, Leandro Gennari, and Aldo Severini. "The Outcome of Cholangitis After Percutaneous Biliary Drainage in Neoplastic Jaundice." HPB Surgery 6, no. 4 (January 1, 1993): 287–93. http://dx.doi.org/10.1155/1993/17078.
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The purpose of this paper is to evaluate factors affecting the outcome of cholangitis after PTBD in jaundiced cancer patients. Twenty nine patients with neoplastic jaundice (male/female ratio 13/16, median age 55 years) with full clinical data, were treated by PTBD and developed cholangitis at a median of 9 days later. Four patients (14%) died of biliary sepsis a median of one month after PTBD while the other 25 survived a median of 6 months, with one week median duration of cholangitis. The probability of the cholangitis resolving was analyzed by time to resolution and it was found that 50% and 100% of the recoveries occurred 5 and 9 months respectively from the onset of the complication.The series was analyzed to determine the role of several variables (disease/patient/treatment related) in the resolution of cholangitis. Only a low stricture site, a large initial drainage catheter (10F) and a temperature increase exceeding 39° C were correlated with a positive outcome. We conclude that PTBD-related cholangitis has, in our experience, a good chance of cure, low mortality rate and satisfactory 6 months median survival.
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Milella, Marco, Monica Salvetti, Annamaria Cerrotta, Guido Cozzi, Elisabetta Uslenghi, Anna Tavola, Gianstefano Gardani, and Aldo Severini. "Interventional Radiology and Radiotherapy for Inoperable Cholangiocarcinoma of the Extrahepatic Bile Ducts." Tumori Journal 84, no. 4 (July 1998): 467–71. http://dx.doi.org/10.1177/030089169808400406.
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Aims and background To evaluate the effectiveness of external radiation therapy (ERT), alone or combined with endoluminal brachytherapy (BRT), following percutaneous transhepatic biliary drainage (PTBD) in the treatment of patients affected by inoperable cholangiocarcinoma. Methods & study design From September 1980 to June 1996, 130 jaundiced patients affected by inoperable cholangiocarcinoma were submitted to PTBD at the Division of Radiology C of the National Cancer Institute of Milan. Nineteen were excluded from the present analysis due to the short survival after PTBD (<30 days). The other 111 patients were divided into three groups according to the following therapy: no further treatment after palliative PTBD in 89 patients (80%, group 1); ERT in 10 patients (9%, group 2); ERT plus BRT in 12 patients (11%, group 3). All the ERT+BRT patients were enrolled after 1990 and were treated with high-energy photon beams followed by en-dobiliary insertion of one or two iridium-192 wires. Results Median overall survival among the 111 assessable patients was 126 days; for groups 1, 2 and 3 it was 108, 345 and 428 days, respectively. The patients submitted to radiotherapy (ERT alone or ERT+BRT) were evaluated by radiologic examinations after the end of radiation. In group 2, a partial remission in 3 cases, a progression of disease in 1 case, and no change in 6 cases were observed. Among the patients of group 3, complete remission in 5 and partial remission in 7 patients were achieved. In all the patients achieving complete remission, the PTBD could be removed. Conclusions The combination of ERT plus BRT improves survival and quality of life of the patients submitted to PTBD for cholangiocarcinoma. Under the technical point of view, radiation treatment is easy to perform, but much caution is required in defining clinical and planning target volumes. Moreover, drainage during the radiation treatment has to be submitted to a very meticulous surveillance.
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McGinnis, Jennifer, Leon Venegas, Hector Lopez, and Brian Kay. "A Recombinant Affinity Reagent Specific for a Phosphoepitope of Akt1." International Journal of Molecular Sciences 19, no. 11 (October 24, 2018): 3305. http://dx.doi.org/10.3390/ijms19113305.
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The serine/threonine-protein kinase, Akt1, plays an important part in mammalian cell growth, proliferation, migration and angiogenesis, and becomes activated through phosphorylation. To monitor phosphorylation of threonine 308 in Akt1, we developed a recombinant phosphothreonine-binding domain (pTBD) that is highly selective for the Akt1 phosphopeptide. A phage-display library of variants of the Forkhead-associated 1 (FHA1) domain of yeast Rad53p was screened by affinity selection to the phosphopeptide, 301-KDGATMKpTFCGTPEY-315, and yielded 12 binding clones. The strongest binders have equilibrium dissociation constants of 160–180 nanomolar and are phosphothreonine-specific in binding. The specificity of one Akt1-pTBD was compared to commercially available polyclonal antibodies (pAbs) generated against the same phosphopeptide. The Akt1-pTBD was either equal to or better than three pAbs in detecting the Akt1 pT308 phosphopeptide in ELISAs.
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Nilsson, Jan, Sam Eriksson, Peter Nørgaard Larsen, Inger Keussen, Susanne Christiansen Frevert, Gert Lindell, and Christian Sturesson. "Concurrent biliary drainage and portal vein embolization in preparation for extended hepatectomy in patients with biliary cancer." Acta Radiologica Open 4, no. 5 (May 1, 2015): 205846011557912. http://dx.doi.org/10.1177/2058460115579121.
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Background Patients with perihilar cholangiocarcinoma and gallbladder cancer extending into the hilum often present with jaundice and a small future liver remnant (FLR). If resectable, preoperative biliary drainage and portal vein embolization (PVE) are indicated. Classically, these measures have been performed sequentially, separated by 4–6 weeks. Purpose To report on a new regime where percutaneous transhepatic biliary drainage (PTBD) and PVE are performed simultaneously, shortening the preoperative process. Material and Methods Six patients were treated with concurrent PTBD and PVE under general anesthesia. Results Surgical exploration followed the combined procedure after 35 days (range, 28–51 days). The FLR ratio increased from 22% to 32%. Three patients developed cholangitis after the procedure. Conclusion The combined approach of PTBD and PVE seems feasible, but more studies on morbidity are warranted.
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Miller, Corey S., Alan N. Barkun, Myriam Martel, and Yen-I. Chen. "Endoscopic ultrasound-guided biliary drainage for distal malignant obstruction: a systematic review and meta-analysis of randomized trials." Endoscopy International Open 07, no. 11 (November 2019): E1563—E1573. http://dx.doi.org/10.1055/a-0998-8129.
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Abstract Background and study aims Endoscopic ultrasound (EUS)-guided biliary drainage (BD) is increasingly used for distal malignant biliary obstruction, yet its safety and efficacy compared to endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage (PTBD) remain unclear. We performed a meta-analysis to improve our understanding of the role of EUS-BD in this patient population. Methods We searched Embase, MEDLINE, CENTRAL, and ISI Web of Knowledge through September 2018 for randomized controlled trials (RCTs) comparing EUS-BD to ERCP-BD or PTBD as treatment of distal malignant biliary obstruction. Risk ratios (RRs) with 95 % confidence intervals (CIs) were combined using random effects models. The primary outcome was risk of stent/catheter dysfunction requiring reintervention. Results Of six trials identified, three (n = 222) compared EUS-BD to ERCP-BD for first-line therapy; three others (n = 132) evaluated EUS-BD versus PTBD after failed ERCP-BD. EUS-BD was associated with a decreased risk of stent/catheter dysfunction overall (RR, 0.39; 95 %CI 0.27 – 0.57) and in planned subgroup analysis when compared to ERCP (RR, 0.41; 95 %CI 0.23 – 0.74) or PTBD (RR, 0.37, 95 %CI 0.22 – 0.61). Compared to ERCP, EUS was associated with a decreased risk of post-procedure pancreatitis (RR, 0.12; 95 %CI 0.01 – 0.97). No differences were noted in technical or clinical success. Conclusions In a meta-analysis of randomized trials comparing EUS-BD to conventional biliary drainage modalities, no difference in technical or clinical success was observed. Importantly, EUS-BD was associated with decreased risks of stent/catheter dysfunction when compared to both PTBD and ERCP, and decreased post-procedure pancreatitis when compared to ERCP, suggesting the potential role for EUS-BD as an alternative first-line therapy in distal malignant biliary obstruction.
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Kambayashi, Komei, Masao Toki, Shunsuke Watanabe, and Tadakazu Hisamatsu. "Management of common bile duct stones in a pregnant woman by percutaneous biliary drainage followed by elective endoscopic stone removal after delivery." BMJ Case Reports 15, no. 3 (March 2022): e248285. http://dx.doi.org/10.1136/bcr-2021-248285.
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A woman in her 30s who was 12 weeks pregnant with her third child presented with jaundice. Blood tests showed elevated hepatobiliary enzymes and direct bilirubin. Abdominal ultrasonography showed dilatation of the common bile duct and strong echo with a 9 mm acoustic shadow in the distal bile duct. She was diagnosed with common bile duct stone disease and biliary drainage was considered necessary. Percutaneous transhepatic biliary drainage (PTBD) was performed considering the effect on both the fetus and the mother, and the procedure was successful without any complications. The PTBD tube was left in place until delivery at 36 weeks 6 days of gestation and endoscopic stone removal was performed 14 days after delivery. The patient was discharged 18 days after delivery without any complications. In pregnant women with common bile duct stones, palliative PTBD followed by elective endoscopic stone removal after delivery can be considered a treatment strategy.
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Obana, Takashi, and Shuuji Yamasaki. "A Case of Malignant Biliary Obstruction with Severe Obesity Successfully Treated by Endoscopic Ultrasonography-Guided Biliary Drainage." Case Reports in Medicine 2016 (2016): 1–5. http://dx.doi.org/10.1155/2016/5249013.
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Here, we present a case of malignant biliary tract obstruction with severe obesity, which was successfully treated by endoscopic ultrasonography-guided biliary drainage (EUS-BD). A female patient in her sixties who had been undergoing chemotherapy for unresectable pancreatic head cancer was admitted to our institution for obstructive jaundice. She had diabetes mellitus, and her body mass index was 35.1 kg/m2. Initially, endoscopic retrograde cholangiopancreatography (ERCP) was performed, but bile duct cannulation was unsuccessful. Percutaneous transhepatic biliary drainage (PTBD) from the left hepatic biliary tree also failed. Although a second PTBD attempt from the right hepatic lobe was accomplished, biliary tract bleeding followed, and the catheter was dislodged. Consequently, EUS-BD (choledochoduodenostomy), followed by direct metallic stent placement, was performed as a third drainage method. Her postprocedural course was uneventful. Following discharge, she spent the rest of her life at home without recurrent jaundice or readmission. In cases of severe obesity, we consider EUS-BD, rather than PTBD, as the second drainage method of choice for distal malignant biliary obstruction when ERCP fails.
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Kongkam, Pradermchai, Theerapat Orprayoon, Chaloemphon Boonmee, Passakorn Sodarat, Orathai Seabmuangsai, Chatchawan Wachiramatharuch, Yutthaya Auan-Klin, et al. "ERCP plus endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage for malignant hilar biliary obstruction: a multicenter observational open-label study." Endoscopy 53, no. 01 (June 8, 2020): 55–62. http://dx.doi.org/10.1055/a-1195-8197.
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Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) may not provide complete biliary drainage in patients with Bismuth III/IV malignant hilar biliary obstruction (MHBO). Complete biliary drainage is accomplished by adding percutaneous transhepatic biliary drainage (PTBD). We prospectively compared recurrent biliary obstruction (RBO) rates between combined ERCP and endoscopic ultrasound-guided biliary drainage (EUS-BD) vs. bilateral PTBD. Methods Patients with MHBO undergoing endoscopic procedures (group A) were compared with those undergoing bilateral PTBD (group B). The primary outcome was the 3-month RBO rate. Results 36 patients were recruited into groups A (n = 19) and B (n = 17). Rates of technical and clinical success, and complications of group A vs. B were 84.2 % (16/19) vs. 100 % (17/17; P = 0.23), 78.9 % (15/19) vs. 76.5 % (13/17; P > 0.99), and 26.3 % (5/19) vs. 35.3 % (6/17; P = 0.56), respectively. Within 3 and 6 months, RBO rates of group A vs. group B were 26.7 % (4/15) vs. 88.2 % (15/17; P = 0.001) and 22.2 % (2/9) vs. 100 % (9/9; P = 0.002), respectively. At 3 months, median number of biliary reinterventions in group A was significantly lower than in group B (0 [interquartile range] 0–1 vs. 1 [1–2.5]), respectively (P < 0.001). Median time to development of RBO was longer in group A than in group B (92 [56–217] vs. 40 [13.5–57.8] days, respectively; P = 0.06). Conclusions Combined ERCP and EUS procedures provided significantly lower RBO rates at 3 and 6 months vs. bilateral PTBD, with similar complication rates and no significant mortality difference.
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Jha, Prabhat, and Paleswan Lakhey. "Evaluation of complications of PTBD using Hull’s Risk Stratification Index." Journal of Society of Surgeons of Nepal 18, no. 3 (July 25, 2016): 29. http://dx.doi.org/10.3126/jssn.v18i3.15292.
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Introduction: Obstructive jaundice is a common surgical problem. Percutaneous transhepatic biliary drainage (PTBD) is one of the effective treatments in the management of biliary obstruction. Hull Risk stratification index has been proposed to identify which patients are more likely to suffer from immediate and early complications and procedural mortality.Materials and Methods: This is a descriptive observational study conducted at the department of surgery TUTH over a period of 1 year between october 2014 and october 2015. Hull risk stratification index was used to predict the complications of the procedure.Results: 79 patients who underwent PTBD were included during the study period of one year. Among them 39(49%) were male and 40(51%) were female. The median age of patients undergoing the procedure was 59yrs (range 35-90yrs). Twenty nine patients (36%) were in the medium Hull risk group, 50 (64%) of patients were in the low risk group and there were no patients in the high risk group. Six patients (7.5%) died after the procedure. Seven patients (8%) developed sepsis following the procedure. One patient (1.2%) developed hemobilia. Two patients (2.4%) developed pneumonia following the procedure. The sensitivity, specificity, positive predictive value, negative predictive value of the index for complications of PTBD were 81%, 74%, 44% and 94% respectively. Patients with medium Hull’s risk were 3 times more likely to develop complications of PTBD than those with low risk.Conclusion: Hull’s Risk Stratification Index can be utilized as a marker for predicting the early, immediate complications as well as procedure related mortality.
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Rasekhi, Alireza, and Nasir Babakhan Kondori. "Causes and Treatment of Bile Leaks at the Puncture Site After Percutaneous Transhepatic Biliary Decompression." American Journal of Interventional Radiology 3 (September 10, 2019): 8. http://dx.doi.org/10.25259/ajir_3_2019.
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Introduction: Bile leaks at the puncture site after percutaneous transhepatic biliary decompression (PTBD) are not uncommon and cause a lot of problems for patients with non-resectable biliary malignant obstruction. However, to the best of the authors’ knowledge, no study is conducted to establish the causes and to find an appropriate treatment. The current study was conducted on 264 patients who underwent PTBD for a malignant biliary obstruction. Material and Methods: This retrospective study reviewed 264 patients with non-resectable malignant biliary obstruction requiring PTBD. A two-stage biliary decompression is done. An 8Fr pigtail catheter is placed for PTBD, the patients would return after two days for stent placement. After stent placement, an 8 Fr pigtail catheter (internal – external) would be placed for flushing, and also for cholangiography. The patients are then observed for another two days. Patients who have persistent puncture site bile leakage after 24 hours are considered to have a bile leak. In these patients, cholangiography is performed. If cholangiography reveals stent occlusion, stent reopening by irrigation/ballooning is done. For those with patent stents and bile leakage, an internal-external biliary drain is placed which does not solve the problem, and a cholangiography is done into the drain tract via a syringe. Results: Sixteen of 264 patients who underwent percutaneous biliary decompression developed bile leakage at the puncture site. Twelve of these patients demonstrated an occluded biliary stent and their bile leak resolved after irrigation/ballooning. Four patients with bile leak demonstrated patent biliary stents and persistent leakage despite internal-external biliary drain placement. Cholangiograms in these patients demonstrated connections from the stented biliary system (the ipsilateral system), branches of a different occluded biliary system (the contralateral biliary tract), and the drain tract. All four patients underwent PTBD of the contralateral biliary system with subsequent resolution of their bile leak. Discussion: One of the complications of PTBD is bile leakage at the puncture site which could have two reasons. The most common is stent occlusion by clot and debris which can be managed by irrigation/ stenting. The second mechanism of bile leakage, not reported previously, was a fistulous connection between the drained biliary system (the ipsilateral system) and a separate obstructed biliary system (the contralateral system). We would like to refer to this mechanism of bile leak “Yo-Yo reflux” for its specific pattern of cholangiography. The Yo-Yo reflux mechanism of bile leaks occurs when a small branch from the adjacent separated contralateral system is transgressed inadvertently during ipsilateral biliary drainage. High-pressure bile fluid from the obstructed system flows through the lower pressure ipsilateral system and through the cannulation tract and onto the skin surface. In the Yo-Yo mechanism, stenting of the contralateral side is the only treatment. Conclusion: Bile leakage at the puncture site after PTBD has two major causes. The most common is stent occlusion by clot/debris which is diagnosed by cholangiography and treated by irrigation/ballooning. The second cause is Yo-Yo reflux which is diagnosed by cholangiography injecting directly into the orifice of skin fistula and treated by contralateral stenting.
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Zakosek, Milos, Dusan Bulatovic, Vedrana Pavlovic, Aleksandar Filipovic, Aleksa Igic, Danijel Galun, Darko Jovanovic, Jelena Sisevic, and Dragan Masulovic. "Prognostic Nutritional Index (PNI) and Neutrophil to Lymphocyte Ratio (NLR) as Predictors of Short-Term Survival in Patients with Advanced Malignant Biliary Obstruction Treated with Percutaneous Transhepatic Biliary Drainage." Journal of Clinical Medicine 11, no. 23 (November 29, 2022): 7055. http://dx.doi.org/10.3390/jcm11237055.
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Background: Effective biliary tree decompression plays a central role in the palliation of malignant biliary obstruction (MBO). When endoscopic drainage is unfeasible or unsuccessful, percutaneous transhepatic biliary drainage (PTBD) is the method of choice and preferred treatment approach in advanced hilar MBO. The prognostic nutritional index (PNI) reflects the patient’s immunonutritional status, while the neutrophil to lymphocyte ratio (NLR) reflects the patient’s inflammation status. The aim of the present study was to evaluate the prognostic value of preprocedural PNI and NLR on short-term survival in the advanced stage MBO population threatened with PTBD and to characterize the differences in immunonutritional and inflammatory status between 60-day survivors and non-survivors, as well as analyze other variables influencing short-term survival. Methods: This single-center retrospective study was conducted on patients undergoing palliative PTBD caused by MBO as a definitive therapeutic treatment between March 2020 and February 2022. After the procedure, patients were followed until the end of August 2022. Results: A total of 136 patients with malignant biliary obstruction were included in the study. Based on receiver operating characteristic (ROC) curve analysis, optimal cut off-values for NLR (3) and PNI (36.7) were determined. In univariate regression analysis, age, absolute neutrophil count, albumin level, NLR ≤ 3, and PNI ≥ 36.7 were significant predictors of 60-day survival. Level of obstruction and PNI ≥ 36.7 were statistically significant independent predictors of 60-day survival in a multivariate regression model. Using PNI ≥ 36.7 as a significant coefficient from the multivariate regression model with the addition of NLR ≤ 3 from univariate analysis, a 60-day survival score was developed. Conclusions: PNI and NLR are easy to calculate from routine blood analysis, which is regularly conducted for cancer patients. As such, they represent easily available, highly reproducible, and inexpensive tests capable of expressing the severity of systemic inflammatory responses in patients with cancer. Our study highlights that preprocedural PNI and NLR values provide predictors of short-term survival in patients with MBO treated with palliative PTBD. In addition, the proposed 60-day survival score can contribute to better selection of future candidates for PTBD and recognition of high-risk patients with expected poor outcomes.
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Joshi, Divyanshu, Y. P. Monga, Shashank Mishra, Rani Bansal, and Sachin Agrawal. "Management of extra hepatic biliary obstruction, in a rural tertiary care hospital India." International Surgery Journal 8, no. 9 (August 27, 2021): 2711. http://dx.doi.org/10.18203/2349-2902.isj20213601.
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Background: Extra hepatic biliary obstruction (EHBO) is not a rare surgical problem; our experience in managing 36 patients over a period of two years at a tertiary care hospital in a rural setting in India. The objective was to study the etiology and clinical presentation of patients with EHBO, role of various investigative modalities and management strategies in these patients and their outcome.Methods: This was a prospective study conducted between September 2018 to August 2020 in the department of surgery in tertiary care center Subharti medical college (SMC) Meerut. Data was taken in a pre-formed performa and the results were tabulated and analyzed (descriptive analysis).Results: Out of 36 patients, 2 (5.5%) patients underwent choledochoduodenostomy, 1 (2.7%) exploratory laparotomy with CBD exploration with t tube drainage, 1 (2.7%) ERCP with pigtail drainage; 17(47.2%) ERCP (endoscopic retrograde cholangiopancreatography) followed by cholecystectomy, 1 (2.7%) open cholecystectomy with t tube drainage, 4 (11.1%) ERCP alone, 2 (5.5%) hepaticojejunostomy, 1 (2.7%) ERCP followed by diverticulectomy, 2 (5.5%) PTBD (percutaneous transhepatic biliary drainage) followed by a triple bypass surgery, 2 (5.5%) PTBD, 1 (2.7%) pylorus preserving pancreaticoduodenectomy, 1 (2.7%) ERCP with sphincterotomy, 1 (2.7%) PTBD followed by whipples procedure. Patients were followed up and 5 (13.8%) patients had recurrence of the disease.Conclusions: EHBO is a hepatobiliary surgical condition caused by both neoplastic and non-neoplastic etiology. Benign pathologies common in younger patients whereas neoplastic conditions in older age. Ultrasonography is the most common investigative modality followed by ERCP with PTBD/ENBD playing an important role in decompression of biliary obstruction as a palliative measure in advanced malignancies.
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Schmitz, Daniel, Carlos T. Valiente, Markus Dollhopf, Manuel Perez-Miranda, Armin Küllmer, Joan Gornals, Juan Vila, et al. "Percutaneous transhepatic or endoscopic ultrasound-guided biliary drainage in malignant distal bile duct obstruction using a self-expanding metal stent: Study protocol for a prospective European multicenter trial (PUMa trial)." PLOS ONE 17, no. 10 (October 27, 2022): e0275029. http://dx.doi.org/10.1371/journal.pone.0275029.
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Background Endoscopic ultrasound-guided biliary drainage (EUS-BD) was associated with better clinical success and a lower rate of adverse events (AEs) than fluoroscopy-guided percutaneous transhepatic biliary drainage (PTBD) in recent single center studies with mainly retrospective design and small case numbers (< 50). The aim of this prospective European multicenter study is to compare both drainage procedures using ultrasound-guidance and primary metal stent implantation in patients with malignant distal bile duct obstruction (PUMa Trial). Methods The study is designed as a non-randomized, controlled, parallel group, non-inferiority trial. Each of the 16 study centers performs the procedure with the best local expertise (PTBD or EUS-BD). In PTBD, bile duct access is performed by ultrasound guidance. EUS-BD is performed as an endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS), EUS-guided choledochoduodenostomy (EUS-CDS) or EUS-guided antegrade stenting (EUS-AGS). Insertion of a metal stent is intended in both procedures in the first session. Primary end point is technical success. Secondary end points are clinical success, duration pf procedure, AEs graded by severity, length of hospital stay, re-intervention rate and survival within 6 months. The target case number is 212 patients (12 calculated dropouts included). Discussion This study might help to clarify whether PTBD is non-inferior to EUS-BD concerning technical success, and whether one of both interventions is superior in terms of efficacy and safety in one or more secondary endpoints. Randomization is not provided as both procedures are rarely used after failed endoscopic biliary drainage and study centers usually prefer one of both procedures that they can perform best. Trial registration ClinicalTrials.gov ID: NCT03546049 (22.05.2018).
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Facciorusso, Antonio, Benedetto Mangiavillano, Danilo Paduano, Cecilia Binda, Stefano Francesco Crinò, Paraskevas Gkolfakis, Daryl Ramai, et al. "Methods for Drainage of Distal Malignant Biliary Obstruction after ERCP Failure: A Systematic Review and Network Meta-Analysis." Cancers 14, no. 13 (July 5, 2022): 3291. http://dx.doi.org/10.3390/cancers14133291.
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There is scarce evidence on the comparison between different methods for the drainage of distal malignant biliary obstruction (DMBO) after endoscopic retrograde cholangiopancreatography (ERCP) failure. Therefore, we performed a network meta-analysis to compare the outcomes of these techniques. We searched main databases through September 2021 and identified five randomized controlled trials. The primary outcome was clinical success. The secondary outcomes were technical success, overall and serious adverse event rate. Percutaneous trans-hepatic biliary drainage was found to be inferior to other interventions (PTBD: RR 1.01, 0.88–1.17 with EUS-choledochoduodenostomy (EUS-CD); RR 1.03, 0.86–1.22 with EUS-hepaticogastrostomy (EUS-HG); RR 1.42, 0.90–2.24 with surgical hepaticojejunostomy). The comparison between EUS-HG and EUS-CD was not significant (RR 1.01, 0.87–1.17). Surgery was not superior to other interventions (RR 1.40, 0.91–2.13 with EUS-CD and RR 1.38, 0.88–2.16 with EUS-HG). No difference in any of the comparisons concerning adverse event rate was detected, although PTBD showed a slightly poorer performance on ranking analysis (SUCRA score 0.13). In conclusion, all interventions seem to be effective for the drainage of DMBO, although PTBD showed a trend towards higher rates of adverse events.
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Liao, Yi-Jun, Wan-Tzu Lin, Hsin-Ju Tsai, Chia-Chang Chen, Chun-Fang Tung, Sheng-Shun Yang, and Yen-Chun Peng. "Critically-Ill Patients with Biliary Obstruction and Cholangitis: Bedside Fluoroscopic-Free Endoscopic Drainage versus Percutaneous Drainage." Journal of Clinical Medicine 11, no. 7 (March 28, 2022): 1869. http://dx.doi.org/10.3390/jcm11071869.
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Severe acute cholangitis is a life-threatening medical emergency. Endoscopic biliary drainage (EBD) or percutaneous transhepatic biliary drainage (PTBD) is usually used for biliary decompression. However, it can be risky to transport a critical patient to the radiology unit. We aimed to compare clinical outcomes between bedside, radiation-free EBD and fluoroscopic-guided PTBD in patients under critical care. Methods: A retrospective study was conducted on critically ill patients admitted to the intensive care unit with biliary obstruction and cholangitis from January 2011 to April 2020. Results: A total of 16 patients receiving EBD and 31 patients receiving PTBD due to severe acute cholangitis were analyzed. In the EBD group, biliary drainage was successfully conducted in 15 (93.8%) patients. Only one patient (6.25%) encountered post-procedure pancreatitis. The 30-day mortality rate was no difference between the 2 groups (32.72% vs. 31.25%, p = 0.96). Based on multivariate analysis, independent prognostic factors for the 30-day mortality were a medical history of malignancy other than pancreatobiliary origin (HR: 5.27, 95% confidence interval [CI]: 1.01–27.57) and emergent dialysis (HR: 7.30, 95% CI: 2.20–24.24). Conclusions: Bedside EBD is safe and as effective as percutaneous drainage in critically ill patients. It provides lower risks in patient transportation but does require experienced endoscopists to perform the procedure.
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Zanvettor, Alex, Wolfgang Lederer, Bernhard Glodny, Andreas P. Chemelli, and Franz J. Wiedermann. "Procedural sedation and analgesia for percutaneous trans-hepatic biliary drainage: Randomized clinical trial for comparison of two different concepts." Open Medicine 15, no. 1 (August 28, 2020): 815–21. http://dx.doi.org/10.1515/med-2020-0220.
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AbstractProcedural sedation and analgesia (PSA) is important during painful dilatation and stenting in patients undergoing percutaneous trans-hepatic biliary drainage (PTBD). A prospective, nonblinded randomized clinical trial was performed comparing different analgesic regimens with regard to the patient’s comfort. Patients were randomly assigned to two treatment groups in a parallel study, receiving either remifentanil or combined midazolam, piritramide, and S-ketamine. The primary study endpoint was pain intensity before, during, and after the intervention using the numerical rating scale (0, no pain; 10, maximum pain). The secondary study endpoint was the satisfaction of the interventional radiologist. Fifty patients underwent PTBD of whom 19 (38.0%) underwent additional stenting. During intervention, the two groups did not differ significantly. After the intervention, the need for auxiliary opioids was higher (12.5% vs 7.7%; p = 0.571) and nausea/vomiting was more frequently observed (33.4% vs 3.8%; p = 0.007) in patients with remifentanil than in patients with PSA. Overall, 45 patients (90.0%) needed additional administration of non-opioid analgesics during postinterventional observation. Remifentanil and combined midazolam, piritramide, and S-ketamine obtained adequate analgesic effects during PTBD. After the intervention, medications with antiemetics and long-acting analgesics were more frequently administered in patients treated with remifentanil (EudraCT No. 2006-003285-34; institutional funding).
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Mohson, Khaleel I., and Zaid Hadi Kadhum. "Role of Interventional Radiology in the Management of Obstructive Jaundice: Achieving Drainage and Stenting." Open Access Macedonian Journal of Medical Sciences 10, B (March 9, 2022): 529–31. http://dx.doi.org/10.3889/oamjms.2022.8438.
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BACKGROUND: Obstructive jaundice due to the central malignant cause is really challenging for gastroenterologists and usually results in failed drainage of obstructing system, the percutaneous transhepatic biliary drainage (PTBD) usually results in a dramatic pathway opening. AIM: The study aimed to evaluate the role of interventional radiology (IR) in achieving drainage of obstructing system and subsequent reduction of serum bilirubin and its role in stenting the obstructing lesion. METHODS: A prospective study included 40 patients who complained of obstructive jaundice referred to IR unit in specialties surgical hospital from gastroenterology hospital after failed endoscopic drainage and stenting during the period from September 2020 to November 2021. RESULTS: Of 40 patients in study population, 26 are male and 14 females, their median age was 65 years, cholangiocarcinoma is leading cause of biliary obstruction, the technical success of PTBD was 100% and clinical success achieved by lowering of total serum bilirubin by 60% within 2 weeks seen in 75% of the patients, no significant major complications seen after procedure, and only 5% of the patients developed leaking bile along the drain tract. CONCLUSIONS: PTBD and transhepatic biliary stenting are amazing technique in acute and chronic management of patients with obstructive jaundice, achieve dramatic lowering of serum bilirubin, fighting biliary sepsis and long-term palliation of advanced biliary, pancreatic, and ampullary malignancy.
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Iruarrizaga, E., E. Azkona, M. Martinez, E. Iza, G. Lopez-Vivanco, A. Munoz Llarena, J. Ferreiro, D. Ballesteros, R. Fernandez, and I. Rubio. "Percutaneous transhepatic biliary drainage (PTBD) and endoscopic retrograde cholangiopancreatography (ERCP) for malignant obstructive jaundice (OJ) in advanced digestive cancers." Journal of Clinical Oncology 29, no. 4_suppl (February 1, 2011): 348. http://dx.doi.org/10.1200/jco.2011.29.4_suppl.348.
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348 Background: OJ is a relatively frequent complication in patients with advanced malignancies that usually causes refractory symptoms and can make chemotherapy (CT) treatment difficult. In the last years, the use of different non-surgical techniques, such as PTBD or ERCP, is increasing. Methods: From Sep-05 to Aug-10, patients with OJ due to advanced digestive cancers who underwent ERCP or PTBD were included. Baseline characteristics, acute and late complications and outcome were retrospectively collected. Jaundice resolution was recognized if bilirubin value decreased to at least grade 1, after the procedure. Overall survival (OS) was calculated from the date of the technique to the date of death or last follow-up. Results: Seventy-six consecutive patients were collected. Male/Female: 52p/24p; Mean age 63.5 y-o (range: 33-85); ECOG performance status 0/1/2/3: 1/37/27/11; Primary tumour: pancreas 30, biliary tract 18, colorectal 16, gastric 7, and gall bladder 5, and of them, 13% were unresectable locally advanced and 87% metastatic. ERCP was used in 59% of the patients and PTBD in 49% and the proportion of intrahepatic and extrahepatic causes were 1:1. Mean hospital stay was 11.3 days (95% CI 1-21). Twenty- six patients (32%) suffered a complication during the hospital stay: 9 cholangitis, 7 catheter obstruction, 2 bleeding, 2 acute pancreatitis and 6 other, and 8 died of procedure-related adverse event. After hospital discharge there were 34% infections, 17% catheter obstruction and 8% other. After the technique OJ was solved (bilirubin nadir) in 49% of the patients and 55% underwent palliative CT. Median OS was 30 weeks (95% CI: 17-42). Conclusions: PTBD and ERCP are appropriate techniques in patients with malignant OJ and can resolve an absolute contraindication for palliative CT. However, major complications are frequent and a relatively high mortality rate should be expected. Therefore an adequate patient selection is crucial to prevent adverse events. No significant financial relationships to disclose.
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Vanella, Giuseppe, Michiel Bronswijk, Geert Maleux, Hannah van Malenstein, Wim Laleman, and Schalk Van der Merwe. "EUS-guided intrahepatic biliary drainage: a large retrospective series and subgroup comparison between percutaneous drainage in hilar stenoses or postsurgical anatomy." Endoscopy International Open 08, no. 12 (November 17, 2020): E1782—E1794. http://dx.doi.org/10.1055/a-1264-7511.
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Abstract Background and study aims Endoscopic ultrasound-guided intrahepatic biliary drainage (EUS-IBD) struggles to find a place in management algorithms, especially compared to percutaneous drainage (PTBD). In the setting of hilar stenoses or postsurgical anatomy data are even more limited. Patients and methods All consecutive EUS-IBDs performed in our tertiary referral center between 2012 – 2019 were retrospectively evaluated. Rendez-vous (RVs), antegrade stenting (AS) and hepatico-gastrostomies (HGs) were compared. The predefined subgroup of EUS-IBD patients with proximal stenosis/surgically-altered anatomy was matched 1:1 with PTBD performed for the same indications. Efficacy, safety and events during follow-up were compared. Results One hundred four EUS-IBDs were included (malignancies = 87.7 %). These consisted of 16 RVs, 43 ASs and 45 HGs. Technical and clinical success rates were 89.4 % and 96.2 %, respectively. Any-degree, severe and fatal adverse events (AEs) occurred in 23.3 %, 2.9 %, and 0.9 % respectively. Benign indications were more common among RVs while proximal stenoses, surgically-altered anatomy, and disconnected left ductal system among HGs. Procedures were shorter with HGs performed with specifically designed stents (25 vs. 48 minutes, P = 0.004) and there was also a trend toward less dysfunction with those stents (6.7 % vs. 30 %, P = 0.09) compared with previous approaches. Among patients with proximal stenosis/surgically-altered anatomy, EUS-IBD vs. PTBD showed higher rates of clinical success (97.4 % vs. 79.5 %, P = 0.01), reduced post-procedural pain (17.8 % vs. 44.4 %, p = 0.004), shorter median hospital stay (7.5 vs 11.5 days, P = 0.01), lower rates of stent dysfunction (15.8 % vs. 42.9 %, P = 0.01), and the mean number of reinterventions was lower (0.4 vs. 2.8, P < 0.0001). Conclusions EUS-IBD has high technical and clinical success with an acceptable safety profile. HGs show comparable outcomes, which are likely to further improve with dedicated tools. For proximal strictures and surgically-altered anatomy, EUS-IBD seems superior to PTBD.
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Spadaccini, Marco, Cecilia Binda, Alessandro Fugazza, Alessandro Repici, Ilaria Tarantino, Carlo Fabbri, Luigi Cugia, and Andrea Anderloni. "Informed Consent for Endoscopic Biliary Drainage: Time for a New Paradigm." Medicina 58, no. 3 (February 22, 2022): 331. http://dx.doi.org/10.3390/medicina58030331.
Full textAbstract:
Endoscopic retrograde cholangiopancreatography (ERCP) is considered as the first option in the management of malignant biliary obstruction. In case of ERCP failure, percutaneous transhepatic biliary drainage (PTBD) has been conventionally considered as the preferred rescue strategy. However, the use of endoscopic ultrasound (EUS) for biliary drainage (EUS-BD) has proved similarly high rates of technical success, when compared to PTBD. As a matter of fact, biliary drainage is maybe the most evident paradigm of the increasing interconnection between ERCP and EUS, and obtaining an adequate informed consent (IC) is an emerging issue. The aim of this commentary is to discuss the reciprocal roles of ERCP and EUS for malignant biliary obstruction, in order to provide a guide to help in developing an appropriate informed consent reflecting the new biliopancreatic paradigm.