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