Percutaneous transhepatic biliary drainage – first step in the palliative treatment of malignant biliary obstruction?

Abstract

Introduction. Percutaneous transhepatic biliary drainage acts as an alternative way to achieve biliary decompression in patients with obstructive jaundice, when endoscopic drainage is unavailabe [1]. This procedure can reduce high serum bilirubin levels, this way achieving better liver function, reducing side effects of jaundice and hiperbilirubinaemia and allowing patients to receive further treatment [2]. Aim of the study. To evaluate the clinical outcomes and possible benefit of an ultrasound guided percutaneous transhepatic biliary drainage as the first step in the palliative treatment of malignant biliary obstruction. Methods: Retrospective review of patients undergoing percutaneous transhepatic biliary drainage from 2014 to 2015 at the Department of Surgery, Hospital of the Lithuanian University of Health Sciences was performed. Patients were reviewed for demographic features, laboratory tests, complications, outcomes (reduction in serum bilirubin level), hospital stay and mortality rate. Results. During the study period 99 patients (43.4% males (n = 40)) with median age of 68.67±11,02 (range 44–95) received 124 successful biliary drainage procedures for malignant obstructive jaundice. Prior the percutaneous drainage procedure 58 patients (58,6%) were unsuccessfully treated by endoscopic retrograde cholangiopancreatography (ERCP). Forty patients (40.4%) were diagnosed with periampullary tumours, thirty patients (30.3%) had proximal/ hilar cholangiocarcinoma and 29 (29.3%) patients had biliary obstruction due to liver metastasis. Acute cholangitis before drainage procedure was present in 52 (52,5%) patients. After drainage procedure total serum bilirubin value decreased in 87 (87,9%) patients (from 293,72±131,9 μmol to 193,11±117,49μmol, p<0.05).Reduction in the levels of Gamma-glutamyl transferase and Alkaline phosphatase was observed in 94 (94.9%) patients. Seventy patients (70.7%) underwent additional interval procedures. [...].