Feasibility and safety of bedside percutaneous biliary drainage in patients with severe cholangitis

Gupta, Pankaj; Maralakunte, Muniraju; Kalra, Naveen; Samanta, Jayanta; Sharma, Vishal; Mandavdhare, Harshal; Dutta, Usha; Kochhar, Rakesh; Sandhu, Manavjit Singh

doi:10.1007/s00261-020-02825-8

Cited by 7 publications

(6 citation statements)

References 12 publications

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“…Most of the patients who failed to respond were on organ support in the ICU. Poor clinical outcomes in this group of patients have also been reported previously (12). EUS-biliary drainage (EUS-BD) is increasingly utilized as a salvage procedure in patients with failed ERCP (18).…”

Section: Discussionmentioning

confidence: 54%

“…A recent study showed that PTBD could be performed safely at the bedside in patients with severe cholangitis in the ICU (12). There were a few limitations to our study.…”

Section: Discussionmentioning

confidence: 89%

“…PTBD after ERCP may be technically difficult due to the pneumobilia and partially decompressed biliary system. Additionally, in patients with severe cholangitis who are on organ support, lack of breath-hold poses a challenge in successful percutaneous access to the biliary system (12). In a study by Church et al comprising 121 patients with initial ERCP failure, PTBD was performed in 9 patients (13).…”

Section: Discussionmentioning

confidence: 99%

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Role of Percutaneous Transhepatic Biliary Drainage as an Adjunct to Endoscopic Retrograde Cholangiopancreatography

Verma

Hema

Gupta

et al. 2022

Journal of Clinical and Experimental Hepatology

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Section: Discussionmentioning

confidence: 54%

“…A recent study showed that PTBD could be performed safely at the bedside in patients with severe cholangitis in the ICU (12). There were a few limitations to our study.…”

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Role of Percutaneous Transhepatic Biliary Drainage as an Adjunct to Endoscopic Retrograde Cholangiopancreatography

Verma

Hema

Gupta

et al. 2022

Journal of Clinical and Experimental Hepatology

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“…The latest small series ( n = 10) by Gupta et al also illustrated that bedside PTBD using USG alone is a safe and technically feasible procedure in critically ill patients. 19 …”

Section: Discussionmentioning

confidence: 99%

Is Ultrasound-guided Bedside Percutaneous Transhepatic Biliary Drainage Safe and Feasible in Critically Ill Patients with Severe Cholangitis? A Preliminary Single-center Experience

Chandel¹,

Singh²,

Tripathy³

et al. 2022

Indian Journal of Critical Care Medicine

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Background and aim Severe cholangitis secondary to biliary obstruction carries high mortality unless biliary drainage is performed urgently. Owing to various patient-related and logistical issues, bedside biliary drainage is considered a salvage therapeutic option. This study aims to evaluate the safety and efficacy of ultrasonography (USG)-guided biliary drainage at the bedside in patients with severe cholangitis admitted to the intensive care unit (ICU). Materials and methods A total of 20 patients with severe cholangitis admitted to ICU who underwent bedside percutaneous transhepatic biliary drainage (PTBD) under USG guidance were retrospectively evaluated. Clinical outcomes, details about the PTBD procedure, and complications were recorded and analyzed. Results Among 20 patients, 13 were male and 7 were female with a mean age of 50.5 years. The most common cause of biliary obstruction was gall bladder malignancy (45%, n = 9) followed by cholangiocarcinoma (25%, n = 5). Left- and right-sided PTBD was performed in 40% ( n = 8) and 35% ( n = 7) patients, respectively, while 25% ( n = 5) of patients underwent bilateral PTBD. The technical success rate was 100%. A total of 65% ( n = 13) of patients were discharged from ICU upon improvement while the remaining 35% ( n = 7) died despite bedside PTBD. None of the patients had any major procedure-related complications. Conclusions Ultrsound-guided bedside PTBD seems to be a safe and effective option in critically ill patients with severe cholangitis when shifting of patients is not feasible. How to cite this article Singh J, Tripathy TP, Patel R, Chandel K. Is Ultrasound-guided Bedside Percutaneous Transhepatic Biliary Drainage Safe and Feasible in Critically Ill Patients with Severe Cholangitis? A Preliminary Single-center Experience. Indian J Crit Care Med 2023;27(1):16–21.

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“…Its clinical impact has been explored by various workers and is well established for the management of malignant biliary tract obstruction (MBTO) [4][5][6]. Advanced non-operable cases are most commonly referred for PTBD if there is pruritus, cholangitis, hilar level blocks, or failure of endoscopic retrograde cholangiography (ERCP) [7][8][9]. While PTBD is essentially considered a palliative procedure, it can decrease the bilirubin level significantly, leading to chemotherapy (CT) induction [4].…”

Section: Introductionmentioning

confidence: 99%

Survival benefit of percutaneous transhepatic biliary drainage for malignant biliary tract obstruction—a prospective study comparing external and internal drainage techniques

et al. 2021

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Purpose To evaluate the clinical results of percutaneous transhepatic biliary drainage (PTBD) in patients with non-operable malignant biliary tract obstruction (MBTO) and the survival benefit of internal drainage. Methods Prospective data of consecutive patients of PTBD from May 2014 to August 2017 was analyzed for 30-day, 90-day and 1-year mortality, and mean survival of patients undergoing external drainage (ED) and internal drainage (ID) using internal-external ring biliary catheterization or biliary stent were compared. Other important variables evaluated were drop in the total bilirubin (TBil) levels, improvement in pain and pruritus, procedure-related complications, and patient satisfaction. Results In 87 cases (54 male, 33 female) with mean age 37.3 y (22-70 y; 95% CI: 31.1 y-43.5 y), 10, 45 and 32 patients underwent stenting, external and internal-external catheterization, respectively (total 152 procedures [> 1 in 35.63%, n = 31]). PTBD resulted in decrease in mean TBil by 8.2738 ± 0.912 mg/dL at 30 days (P < 0.001), 55.14% (n = 48) cases reaching 3 mg/dL at mean 45 days, and 35/48 cases received chemotherapy. Overall mortality was 6.89%, 37.93% and 90.80% at 30 days, 90 days and 1 year, respectively. Mean survival with ID (236.40 ± 33.37 days) was better than with ED (110.35 ± 26.16 days) (P < 0.001). Pain (62.06%; n = 54; mean Visual Analog Scale [VAS] score = 6.7) improved significantly (mean VAS score 3.4; P < 0.001). Pruritus (n = 29) was relieved in 100% of the cases. Complication rate of 18.39% (n = 16) and no procedure-related death were seen. Conclusion PTBD offers a safe and significant improvement in TBil, pain, and pruritus in non-operable MBTO, with ID offering additional survival benefit over ED.

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Feasibility and safety of bedside percutaneous biliary drainage in patients with severe cholangitis

Cited by 7 publications

References 12 publications

Role of Percutaneous Transhepatic Biliary Drainage as an Adjunct to Endoscopic Retrograde Cholangiopancreatography

Role of Percutaneous Transhepatic Biliary Drainage as an Adjunct to Endoscopic Retrograde Cholangiopancreatography

Is Ultrasound-guided Bedside Percutaneous Transhepatic Biliary Drainage Safe and Feasible in Critically Ill Patients with Severe Cholangitis? A Preliminary Single-center Experience

Survival benefit of percutaneous transhepatic biliary drainage for malignant biliary tract obstruction—a prospective study comparing external and internal drainage techniques

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