The outcomes of biliary drainage by percutaneous transhepatic cholangiography for the palliation of malignant biliary obstruction in England between 2001 and 2014: a retrospective cohort study

IntroductionRelieving obstructive jaundice in inoperable pancreato-biliary cancers improves quality of life and permits chemotherapy. Percutaneous transhepatic cholangiography with drainage and/or stenting relieves jaundice but can be associated with significant morbidity and mortality. Percutaneous transhepatic biliary drainage (PTBD) in malignant biliary obstruction was therefore examined in a national cohort to establish risk factors for poor outcomes.MethodsRetrospective study of adult patients undergoing PTBD for palliation of pancreato-biliary cancer in England between 2001 and 2014 identified from Hospital Episode Statistics. Multivariate logistic regression analysis was used to examine associations with mortality and the need for a repeat PTBD within 2 months.Results16 822 patients analysed (median age 72 (range 19–104) years, 50.3% men). 58% pancreatic and 30% biliary tract cancer. In-hospital and 30-day mortality were 15.3% (95% CI 14.7% to 15.9%) and 23.1% (22.4%–23.8%), respectively. 20.2% suffered a coded complication within 3 months. Factors associated with 30-day mortality: age (≥81 years OR 2.68 (95% CI 2.37 to 3.03), p<0.001), increasing comorbidity (Charlson score 20+, 3.10 (2.64–3.65), p<0.001), pre-existing renal dysfunction (2.37 (2.12–2.65), p<0.001) and non-pancreatic cancer (unspecified biliary tract 1.28 (1.08–1.52), p=0.004). Women had lower mortality (0.91 (0.84–0.98), p=0.011), as did patients undergoing PTBD in a ‘higher volume’ provider (84–180 PTBDs per year 0.68 (0.58–0.79), p<0.001).ConclusionsIn patients undergoing PTBD for the palliation of malignant biliary obstruction, 30-day mortality was high at 23.1%. Mortality was higher in older patients, men, those with increasing comorbidity, a cancer site other than pancreas and at ‘lower-volume’ PTBD providers.

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A Case of Malignant Biliary Obstruction with Severe Obesity Successfully Treated by Endoscopic Ultrasonography-Guided Biliary Drainage

Case Reports in Medicine ◽

10.1155/2016/5249013 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Takashi Obana ◽

Shuuji Yamasaki

Keyword(s):

Biliary Tract ◽

Endoscopic Ultrasonography ◽

Biliary Drainage ◽

Biliary Obstruction ◽

Severe Obesity ◽

Pancreatic Head ◽

Biliary Tree ◽

Malignant Biliary Obstruction ◽

Metallic Stent ◽

Pancreatic Head Cancer

Here, we present a case of malignant biliary tract obstruction with severe obesity, which was successfully treated by endoscopic ultrasonography-guided biliary drainage (EUS-BD). A female patient in her sixties who had been undergoing chemotherapy for unresectable pancreatic head cancer was admitted to our institution for obstructive jaundice. She had diabetes mellitus, and her body mass index was 35.1 kg/m2. Initially, endoscopic retrograde cholangiopancreatography (ERCP) was performed, but bile duct cannulation was unsuccessful. Percutaneous transhepatic biliary drainage (PTBD) from the left hepatic biliary tree also failed. Although a second PTBD attempt from the right hepatic lobe was accomplished, biliary tract bleeding followed, and the catheter was dislodged. Consequently, EUS-BD (choledochoduodenostomy), followed by direct metallic stent placement, was performed as a third drainage method. Her postprocedural course was uneventful. Following discharge, she spent the rest of her life at home without recurrent jaundice or readmission. In cases of severe obesity, we consider EUS-BD, rather than PTBD, as the second drainage method of choice for distal malignant biliary obstruction when ERCP fails.

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Multidisciplinary Approach to Malignant Biliary Obstruction

Digestive Disease Interventions ◽

10.1055/s-0040-1717085 ◽

2020 ◽

Vol 04 (03) ◽

pp. 323-333

Author(s):

Derek Taeyoung Kim ◽

Uzma Rahman ◽

Robert W. Tenney ◽

Oleandro A. Cercio Roa ◽

Pawan Rastogi ◽

...

Keyword(s):

Biliary Drainage ◽

Biliary Obstruction ◽

Multidisciplinary Approach ◽

Percutaneous Transhepatic Cholangiography ◽

Preoperative Biliary Drainage ◽

Malignant Biliary Obstruction ◽

Plastic Stents ◽

Metal Stents ◽

Covered Stents ◽

Case Examples

AbstractTreatment of malignant biliary obstruction (MBO) requires the coordination of multiple specialties, including oncologists, surgeons, gastroenterologists, and interventional radiologists. If the tumor is resectable, surgical candidates can usually proceed to surgery without preoperative biliary drainage. For patients who undergo biliary drainage, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) combined with biliary stenting are techniques with comparable technical success and mortality, each with distinct advantages and risks. Advances in endoscopic ultrasound allow drainage in patients with challenging anatomy. There are a multitude of devices used for biliary decompression. Self-expanding metal stents (SEMS), with longer patency rates, are in most instances preferred over plastic stents for MBO, especially in patients with life expectancy more than 3 to 4 months. Advantages of covered SEMS versus uncovered SEMS remain controversial as covered stents can prevent tumor ingrowth but at the expense of potential increase in stent migrations. Extra-anatomic biliary drainage using lumen-apposing metal stents is an emerging technique which shows promise when conventional ERCP fails. It is imperative to understand these techniques when tailoring a treatment strategy. The goal of this article is to discuss a multidisciplinary approach for MBO to promote comprehensive care using case examples to highlight essential principles.

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Chemotherapy Improves Survival After Percutaneous Biliary Drainage in Patients With Pancreatic or Biliary Tract Cancer With Biliary Obstruction

Anticancer Research ◽

10.21873/anticanres.15079 ◽

2021 ◽

Vol 41 (6) ◽

pp. 2979-2984

Author(s):

JARMO NIEMELÄ ◽

HANNU SYRJÄLÄ ◽

PASI OHTONEN ◽

JUHA SAARNIO ◽

RAIJA KALLIO

Keyword(s):

Biliary Tract ◽

Biliary Tract Cancer ◽

Biliary Drainage ◽

Biliary Obstruction ◽

Percutaneous Biliary Drainage ◽

Tract Cancer

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Assessment of Malignant Biliary Obstruction by Percutaneous Transhepatic Cholangiography: A Prospective Cohort Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/50270.15137 ◽

2021 ◽

Author(s):

Tushant Kumar ◽

Pramod Kumar Dixit ◽

Pramod Kumar Singh

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Biliary Drainage ◽

Biliary Obstruction ◽

Magnetic Resonance Cholangiopancreatography ◽

Percutaneous Transhepatic Cholangiography ◽

Malignant Biliary Obstruction ◽

Mr Cholangiography ◽

Common Block

Introduction: Malignant Biliary Obstruction (MBO) is caused by hepatic metastasis, gall bladder carcinoma, other distant metastasis, icteric hepatocellular carcinoma and lymphoma. Different signs and symptoms of obstruction includes pruritus, jaundice, altered food taste, renal dysfunction, anorexia, malnutrition which ultimately leads to impaired immune dysfunction and impaired quality of life. Aim: To determine the extent of biliary ductal involvement in patients with MBO through Magnetic Resonance Cholangiopancreatography (MRCP) and Percutaneous Transhepatic Cholangiography (PTC) technique and to compare the number of biliary drainage required. Materials and Methods: A prospective cohort study was undertaken at Department of Radiodiagnosis, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India. It included total 40 patients (24 females and 16 males) with strong clinicopathological and laboratory investigation suspicious of MBO. Patients with suspected MBO were examined with MR cholangiography. All patients then underwent PTC and Biliary Drainage (PTBD) and/or stent placement after MR cholangiography. The statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Results: As out of 40 patients, 16 (40%) were males and 24 (60%) were females and the mean age was 53.87±9.49 years with maximum age noted to be 75 years and minimum age of patient in study was 35 years. The most common block observed on MRCP was type IIIA (35%) and after MRCP the distribution of level of hilar block on PTC was obtained with the most common block found was of type II (32.5%). Maximum number of biliary drains during PTBD was three. In MRCP three biliary drain were used in 47.5% patients while in PTC it was used only in 40% patients. Conclusion: Based on diagnostic performance, PTC was found to be superior for the assessment of MBO. PTC played an important role in scheduling the therapeutic strategy for malignant biliary stricture.

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Predictive Factors of Chemotherapy Initiation after Biliary Drainage for Advanced Biliary Tract Cancer: A Retrospective Multicenter Study

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld-3120 ◽

2021 ◽

Author(s):

Miloud Azarfane ◽

Astrid Lievre ◽

Helene Senellart ◽

Beatrice Desomme ◽

Pauline Guillouche ◽

...

Keyword(s):

Multivariate Analysis ◽

Biliary Tract ◽

Predictive Factors ◽

Biliary Tract Cancer ◽

Biliary Drainage ◽

Biliary Obstruction ◽

Male Gender ◽

Biliary Tract Cancers ◽

Tract Cancer ◽

Chemotherapy Initiation

Background and Aims: In unresectable biliary tract cancers, the management of biliary obstruction is often the first step before introduction of chemotherapy. Our aim was to study the predictive factors of chemotherapy initiation after biliary drainage in a series of patients presenting with advanced biliary tract cancer and obstructive jaundice. Methods: Data of all patients treated for unresectable biliary tract cancer with initial biliary obstruction requiring a drainage in six institutions, from January 2009 to January 2019, were retrospectively collected. Results: Among 82 patients included in this study (median age 68 years, men 61%), 48 (59%) received chemotherapy. Median overall survival was 4.9 months (0.2-38.7) in the group of patients who did not receive chemotherapy and 12.2 months (1.9-61.0) in chemotherapy group (HR=2.93; 95%CI: 1.6-5.3; p<0.0001). In univariate analysis, younger age, male gender, Eastern Cooperative Oncology Group (ECOG) score ≤2, high albumin level, low C-reactive protein level, and endoscopic drainage were significantly associated with introduction of chemotherapy. In multivariate analysis, only ECOG score ≤2 at diagnosis (HR=70.4; 95%CI: 4.6-1097.6; p=0.002) and male gender (HR=5; 95%CI: 1.5-16.5; p=0.009), were significant independent predictive factors of chemotherapy introduction. Age and bilirubin level at diagnosis were not significant factors in multivariate analysis. Conclusions: ECOG score ≤ 2 and male gender were the only independent predictive factors of chemotherapy introduction in unresectable biliary tract cancers. Age or initial bilirubin level were not predictors for chemotherapy introduction. These results might help defining the initial therapeutic strategy.

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