Introduction Percutaneous transhepatic cholangiography (PTC) is a procedure used to access the biliary tree for diagnostic purposes in obstructive jaundice, and to facilitate palliative stenting across biliary strictures. A previous study has shown a 19.8% in-patient mortality and significant morbidity for PTC.1 Our aim was to audit local practice in order to identify risk factors for complications and death and to identify ways of reducing patient exposure to PTC.
Methods Retrospective Audit of all patients presenting to Nottingham University Hospitals from 1 October 2010 to 31 December 2010. Patient demographics, indication for PTC, co-morbidities, previous ERCP procedures performed, length of stay, PTC procedural details, morbidity and 30-day mortality was documented from electronic and paper records.
Results 44 patients underwent 72 procedures with a median of 1.5 procedures per patient. Median age was 67 years (IQR 62–77), 42% were female and malignant disease was seen in 91% of patients undergoing PTC. In 68% of procedures the patients had one or more co-morbid conditions. 47% of procedures were for 1st PTC and 53% were for 2nd or subsequent PTC. Overall, failed ERCP was the indication in 36% of procedures, reasons for ERCP failure were; failed cannulation (50%); inability to cross stricture (25%); hilar stricture (11%). Median length of stay was 10 days for all procedures, two patients went home the day of procedure. Frequencies for each indication for PTC were; 38% distal; 27% mid-CBD/CHD stricture; 8% hilar stricture; 7% multiple strictures; 20% other. Intended drainage was achieved in all but one patient and the stricture was crossed in 93% procedures. Median pre-procedural bilirubin was 184 μmol/l (IQR 78–271) with a delta bilirubin at 72 h post PTC of 33 μmol/l (2–89). Overall complications were seen in 41% patients; 17% minor complications (pain and biliary sepsis) and 24% suffered major complications including severe sepsis and renal failure. 30-day mortality was 18% with 13% being secondary to complications. Median survival overall was 182 days (IQR 81–321). Association with early death were Age*, ≥1 co-morbidities*, 72 h post-procedural creatinine*, complications, hilar stricture** and pre-procedural eGFR** (*p<0.05, **p<0.01).
Conclusion PTC is associated with a high incidence of complications and 30-day mortality. Risk factors for poor outcome include patient age; co-morbidity and renal function. Outcomes will likely be improved by better patient selection and pre-procedural optimisation. MRCP as part of the diagnostic pathway may identify strictures that should proceed directly to PTC and those where definitive stenting with cytology can be offered as a single-step procedure.
Competing interests None declared.
Reference 1. Uberoi R, et al. British Society of Interventional Radiology: Biliary Drainage and Stenting Registry (BDSR). Cardiovasc Intervent Radiol 2011.
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