Introduction Percutaneous transhepatic biliary drainage (PTBD) and stenting, though invaluable in relieving difficult biliary obstruction, carry a high morbidity and mortality. This retrospective study examined the incidence and nature of procedure-related complications and survival in a large district general hospital.

Method Between April 2010 and December 2013, 66 consecutive patients who underwent PTBD were studied by analysing the radiology database and patient hospital records.

Results 61% of patients were male. Median age at time of procedure was 72.5 years (interquartile (IQ) range 61–80.75). 90.9% of patients had malignancy and 9.1% had benign disease (gallstones (7.6%), chronic pancreatitis (1.5%)). The most common indication for PTBD was primary pancreaticobiliary cancer (71.2%), followed by secondary liver metastases (19.7%). 53% had occlusion at the distal common bile duct; 39.4% at the hilum; 7.5% had intrahepatic obstruction.

Endoscopic retrograde cholangiopancreatography had been performed previously in 77.3%. Prior to intervention 37.9% were treated for cholangitis. 92% received antibiotics (treatment or prophylaxis) pre-procedure. Median pre-procedure bilirubin was 275 μmol/L (IQ range 156–357 μmol/L). A one-step procedure was performed in 51.5%. 48.5% underwent 2 or more interventions. Unilateral drainage was carried out in 68.2%, bilateral in 16.7% and a rendezvous procedure in 6%. 84.8% received antibiotics post-procedure.

Overall procedural success was high, with technical success and relief of biliary obstruction achieved in 93.9%. Drainage was effective at reducing bilirubin levels by greater than 50% at 7 days post-procedure in 68.2% (median bilirubin 108 μmol/L(IQ range 53–166)).

33.3% of patients experienced at least one complication post-PTBD. Culture positive cholangitis was seen in 19.7%. Acute kidney injury was detected in 12.1%. Other complications included abscess formation (9.1%), procedure failure (6.1%), haemorrhage (4.5%), pneumonia (3%), stent occlusion at 1 month (3%), stent migration at 1 month (1.5%) and local wound infection (1.5%).

Inpatient mortality was 24.2% and 30-day mortality was 28.8%.

Deceased patients at 30 days had significantly higher creatinine levels (p = 0.02) and significantly lower albumin levels (p = 0.003) pre-intervention than surviving patients.

Conclusion This study highlights that complication and mortality-rates remain high post-PTBD and lays emphasis on the need for national guidelines on peri-procedural management, and careful patient selection. We demonstrate that our performance at a large district general hospital is comparable to national data.¹

Disclosure of interest None Declared.

Reference

1. Uberoi R, Robertson I. First Biliary Drainage and Stent Audit Report. The British Society of Interventional Radiology, 2009.