Introduction of percutaneous transhepatic biliary drainage to manage malignant obstruction in Tanzania

Abstract

Objective: Evaluation of outcomes and safety of percutaneous transhepatic biliary drainage (PTBD), which was recently introduced in Tanzania (Tz) as a minimally invasive treatment option for patients with malignant biliary obstruction.

Design: Retrospective evaluation of procedural outcomes in patients who underwent PTBD between October 2018 until April 2021.

Setting: Department of Interventional Radiology (IR) at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania.

Participants: Patients with malignant biliary obstruction who were not surgical candidates and were referred to the IR service.

Interventions:Depending on presentation, patients underwent biliary drain placement with or without biliary stenting. Pre- and post- procedural serum bilirubin levels and clinical evaluation of jaundice and pruritus were recorded.

Main outcome measures: Laboratory, clinical, technical success, and complication rates were calculated. Statistical analysis was performed using SPSS version 20.0.

Results: Out of 49 total patients, external biliary drains were placed in 29, internal-external drains were placed in 19, and metallic stents were placed in 12. The technical success rate was 98% (48/49). There were 5 minor complications and no major complications. Average total bilirubin decreased from 268.8 umol/L pre-procedure to 175.7 umol/L two weeks post-procedure (p=0.017). 94% of patients reported improvement of jaundice and pruritus. Two patients were able to initiate chemotherapy following PTBD. The mean survival for all patients was 196 days.

Conclusion: The introduction of PTBD in Tanzania provides patients with inoperable malignant biliary obstruction with new and effective treatment options resulting in improvement in quality of life.