Purpose Percutaneous biliary drainage (PBD) is used to relieve malignant bile duct obstruction (MBO) when endoscopic drainage is not feasible. Little is known about the effects of PBD on the quality of life (QoL) in patients with MBO. The aim of this study was to evaluate changes in QoL and pruritus after PBD and to explore the variables that impact these changes. Patients and Methods Eligible patients reported their QoL and pruritus before and after PBD using the Functional Assessment of Cancer Therapy – Hepatobiliary instrument (FACT-HS) and the Visual Analog Scale for Pruritus (VASP). Instruments were completed pre-procedure and at one and four weeks following PBD. Results One hundred and nine (60 male/49 female) patients enrolled, 102 (94%) had unresectable disease. PBD was technically successful (hepatic ducts cannulated at the conclusion of procedure) in all patients. There were two procedure-related deaths. All-cause mortality was 10% (N=11) at 4 weeks and 28% (N=31) at 8 weeks post PBD with a median survival of 4.74 months. The mean FACT-HS scores declined significantly (P<.01) over time (101.3, 94.8, 94.7 at baseline, 1 week, 4 weeks, respectively). The VASP scores showed significant improvement at 1 week with continued improvement at 4 weeks (P<.01). Conclusion PBD improves pruritus but not QoL in patients with MBO and advanced malignancy. There is high early mortality in this population.

Background Hepatic artery embolization (HAE) is used commonly to treat liver tumors or hemorrhage. Infectious complications are rare, but carry high morbidity and mortality. Identification of clinical factors associated with post-embolization abscess may improve management and outcome. Methods Clinical and pathologic variables of patients treated with HAE were collected and analyzed to determine the etiology, incidence, and outcome of pyogenic hepatic abscess. Results From January 1998 to January 2010, 971 patients underwent 2,045 HAE procedures. Fourteen patients developed a pyogenic hepatic abscess following embolization for an overall rate of 1.4%. Thirty-four patients (4%) had a history of bilioenteric anastomosis (BEA) and 21 patients (2%) lacked a competent sphincter of Oddi due to the presence of a biliary stent (N=19) or a prior sphincterotomy (N=2). Eleven (33%) of the 34 patients with a BEA and 2 (10%) of 21 patients with an incompetent sphincter developed abscesses, in contrast to only 1 abscess (0.05%) among the 916 patients with apparently normal sphincters (0.1%, OR 437.6 (95% CI 54.2 – 3,533, p<0.0001). Gram negative and gram positive aerobes were the most common bacteria isolated following drainage. Percutaneous drainage was the initial management strategy in all patients; 2 patients (14%) required subsequent surgical drainage and hepatectomy and 3 (21%) died. Conclusion Pyogenic hepatic abscess is rare after HAE. A history of BEA or an incompetent sphincter of Oddi due to a biliary stent or prior sphincterotomy substantially increases in the likelihood of this highly morbid and potentially fatal complication.

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Purpose: To assess outcomes of capping trials among patients with complete aspiration of retained contrast from bladder via NUT. Materials: Our Institutional Review Board approved retrospective review of all NUT placement, NUT exchange and conversion of nephrostomy catheter into NUT performed during June 2013 to June 2015 (n ¼ 578). Cases were excluded due to lack of imaging of bladder (n ¼ 37), incomplete aspiration of bladder (n ¼ 324), no attempt at capping NUT (n ¼ 166),others including non-compliant bladder, bladder outlet obstruction and catheter malposition (n ¼ 14). Study group consisted of 37 procedures in 34 patients (male 19, female 15, age 2-83 years, average 58, median 61) mostly with cancer (prostate 8, endometrial 5, bladder 4, colorectal 4, breast 2, gastric 2, neuroblastoma 2, cervical 1, ovarian 1, renal 1, sarcoma 1, urothelial 1 and testicular 1) and one with Crohn's. Medical records were reviewed to assess outcomes of capping trial. Exact 95% confidence intervals (95%CI) were calculated. Results: Among patients with complete aspiration of retained contrast, 30 (81%, 95%CI: 65%-92%) catheters were successfully capped (range, 12-94 days, average 40, median 24.5) until planned conversion to internal stent (23), routine exchange (5), removal (1) or death unrelated to catheter (1). Substantially fewer procedures were unsuccessful; 7 (19%, 95%CI: 8%-35%) capping trials were unsuccessful (range, 2-22 days, average 12, median 10) due to leakage (3), elevated creatinine (2), fever/hematuria (1) and nausea/ vomiting (1). Conclusions: There is high likelihood of capping trial success among patients with complete aspiration of retained contrast from bladder via NUT.

BACKGROUND Ureteral stent and nephroureterostomy tube (NUT) are treatments of ureteral obstruction. Ureteral stent provides better quality of life. Internalization of NUT is desired whenever possible. AIM To assess outcomes of capping trial among cancer patients with complete aspiration of retained contrast from bladder via NUT. METHODS Our Institutional Review Board approved retrospective review of all NUT placement, NUT exchange and conversion of nephrostomy catheter into NUT performed during June 2013 to June 2015 ( n = 578). Cases were excluded due to lack of imaging of bladder ( n = 37), incomplete aspiration of bladder ( n = 324), no attempt at capping NUT ( n = 166), and patients with confounding factors interfering with results of capping trial including non-compliant bladder, bladder outlet obstruction and catheter malposition ( n = 14). Study group consisted of 37 procedures in 34 patients (male 19, female 15, age 2-83 years, average 58, median 61) most with cancer (prostate 8, endometrial 5, bladder 4, colorectal 4, breast 2, gastric 2, neuroblastoma 2, cervical 1, ovarian 1, renal 1, sarcoma 1, urothelial 1 and testicular 1) and one with Crohn’s disease. Medical records were reviewed to assess outcomes of capping trial. Exact 95% confidence intervals (95%CI) were calculated. RESULTS Among patients with complete aspiration of retained contrast, 30 (81%, 95%CI: 0.65-0.92) catheters were successfully capped (range 12-94 d, average 40, median 24.5) until planned conversion to internal stent (23), routine exchange (5), removal (1) or death unrelated to catheter (1). Seven capping trials (19%, 95%CI: 0.08-0.35) were unsuccessful (range 2-22 d, average 12, median 10) due to leakage (3), elevated creatinine (2), fever/hematuria (1) and nausea/vomiting (1). CONCLUSION Capping trial success among patients with complete aspiration of retained contrast/ urine from bladder via NUT appears high.