Percutaneous drainage and stenting for palliation of malignant bile duct obstruction

Abstract

Percutaneous biliary drainage and stenting (PTBD) for palliation of malignant obstructive jaundice has evolved to a safe and effective technique. PTBD is equally effective for treatment of distal and proximal bile obstruction. Metal self-expandable stents have proved superior to plastic stents and should therefore be used. Technical success is >90% en clinical success is >75% in all major series. There are a considerable number of complications, but most can be treated conservatively and procedure-related mortality is <2% in most series. Thirty-day mortality after PTBD is >10% in many series, but this is largely due to the underlying disease. About 10-30% of patients will have recurrent jaundice at some point in their disease after PTBD and require re-intervention.

Prediction of survival following percutaneous biliary drainage for malignant biliary obstruction

“…[8] Most of the times, malignant tumors causing bile duct obstruction have a very poor prognosis. [9,10] The primary tumors associated with MBO include biliary tract, pancreatic, hepatocellular and duodenal. Metastasis to the porta hepatis from gastric, colon, and breast cancer is another cause of MBO.…”

“…Other possible complications include pain, biliary leakage around puncture site, hemorrhage, perforation, infections and stent migration. [8,9,15,16] Therefore, it is really important to weigh the potential benefits and risks of this procedure in patients with MBO.…”

Triple metallic stenting in hilar malignant biliary obstructions

“…Percutaneous biliary interventions in the setting of malignant biliary obstructions are safe and effective techniques to relieve obstructive symptoms in the case of unresectable tumors (1)(2)(3)(4)(5)(6)(7)(8)(9). The percutaneous approach is the preferred method, especially for high-level obstructions, or for low-level obstructions in which previous endoscopic approaches have failed.…”

“…Patients will not have an uncomfortable external catheter and the associated risk of infection. Metallic stenting can be achieved by the percutaneous approach, the endoscopic approach or by a combination of both (2,3,5).…”

“…All patients underwent percutaneous transhepatic cholangiography (PTC). The techniques for PTC and drainage were the same as previously reported in detail (2,4,5,7,16). In most of the patients three sessions were required for treatment.…”