Biliary duct obstruction treatment with aid of percutaneous transhepatic biliary drainage

Abstract

Introduction: Percutaneous Transhepatic Biliary Drainage (PTBD) is a procedure indicated in patients with non-operative lesions, when endoscopic application of prosthesis is impossible due to anatomic reasons, complications or severe general condition of patient. Most often it is a palliative procedure, aiming for live-quality improvement, although not altering prognosis of basic disease.

Aim: This study presents own experience in biliary drainage with the aid of  percutaneous transhepatic method and simultaneous assessment of method effectiveness and safety. The aim was to assess outcomes and complications of PTBD in a large group of patients.

Materials and method: In time period 2007–2014, 167 patients hospitalized in Radiodiagnostics and Radiology Department of Clinical Hospital, were investigated retrospectively. PTBD procedure was applied to patients with biliary tract  obstruction. In total 186 procedures of percutaneous drainage were applied. Average age of patients was 63.6 years. Bilirubin, alkaline phosphatase and gamma-glutamyl transferase were measured before and after procedure. All data were analyzed statistically.

Results: In examined group percutaneous drainage was successful in 90.7% interventions. In 8.1% procedures drainage application was ineffective. The most common complication during procedure was hemobilia (3.2%) and the long term complication was drain dislocation (2.7%). The mean bilirubin levels declined from 397.06 lmol/l before drainage to 297.88 lmol/l after drainage (p< 0.05).

Conclusions: PTBD is an effective method of biliary tract decompression and it is an important alternative to endoscopic drainage. This method is indicated in patients with neoplastic obstruction of biliary tract with low expected survival rate and thus is a palliative procedure.

Keywords: Biliary drainage; Transhepatic cholangiography; Jaundice;  Decompressed ducts; Biliary complications; Biliary tract obstruction