Percutaneous transhepatic biliary drainage (PTBD) in patients with dilated vs. nondilated bile ducts: technical considerations and complications

Abstract

Objectives The aim of this study was to compare success, technical complexity, and complication rates of percutaneous transhepatic biliary drainage (PTBD) in patients with dilated vs. nondilated bile ducts. Methods In a retrospective analysis, we evaluated all consecutive PTBD performed in our department over a period of 5 years. Technical success, technical data (side, fluoroscopy time, radiation dose, amount of contrast media, use of disposable equipment), procedure-related complications and peri-interventional mortality were compared for patients with dilated vs. non-dilated bile ducts. Independent t test and χ2 test were used to evaluate the statistical significance. Results A total of 253 procedures were performed on 187 patients, of whom 101/253 had dilated bile ducts and 152/253 not. In total, 243/253 procedures were successful. PTBD was significantly more often successful in patients with dilated vs. nondilated bile ducts (150/153 vs. 93/101; p 0.02). Overall complication rate (13%) did not differ significantly between patients with dilated vs. nondilated bile ducts. Procedures in patients with normal, nondilated bile ducts were associated with a significantly higher rate of post-interventional bleeding (5/101 vs. 0/152). Mean fluoroscopy time (42:36 ± 35:39 h vs. 30:28 ± 25:10 h; p 0.002) and amount of contrast media (66 ± 40 ml vs. 52 ± 24 ml; p 0.07) or use of disposables were significantly higher in patients with nondilated ducts. A significantly lower fluoroscopy time and amount of contrast medium were used in left hepatic PTBD. Conclusion Despite the higher technical complexity, PTBD with nondilated bile ducts was associated with similar overall complication rates but higher bleeding complications compared with PTBD with dilated bile ducts. Key Points • PTBD was associated with similar overall complication rates in patients with dilated vs. nondilated bile ducts. • Although overall complication rates were low, PTBD in patients with nondilated bile ducts was associated with a higher incidence of post-interventional bleeding. • PTBD in patients with nondilated bile ducts is technically more complex.

The experience of use of percutaneous transhepatic biliary drainages for early biliary complications after liver transplantation

“…These values were significantly lower than those in patients with dilated IHBDs 22 . Higher rates of PTBD‐related complications, such as sepsis, internal bleeding, lung injuries, abdominal viscera, hepatic artery, or portal vein, and death, were also encountered in LT patients, especially LDLT recipients, without dilated IHBDs 9,12,13,15 …”

“…Some studies have reported on PTBD drainage for a variety of indications, including bile duct complications or postoperative bile leaks after LT, and suggested its feasibility in patients with nondilated bile ducts with similar technical success and complication rates 12,23,32,33 . However, most of these reports discussed the use of PTBD in non‐LT patients with nondilated IHBDs, and other procedures including T‐tube drainage or temporary gall bladder drainages 33 …”

“…Owing to its technical complexity, PTBD in patients with nondilated intrahepatic bile ducts (IHBDs) has a higher complication rate and a lower success rate than in patients with dilated IHBDs 11,12 12,13 12 .…”

“…[2][3][4]10 Owing to its technical complexity, PTBD in patients with nondilated intrahepatic bile ducts (IHBDs) has a higher complication rate and a lower success rate than in patients with dilated IHBDs. 11,12 Lethal complications, such as massive internal bleeding or fistulae between the bile ducts, portal veins, or hepatic arteries, may follow PTBD procedures in patients who develop biliary complications, especially in those with nondilated IHBDs. 12,13 However, these data are under controversial.…”

“…11,12 Lethal complications, such as massive internal bleeding or fistulae between the bile ducts, portal veins, or hepatic arteries, may follow PTBD procedures in patients who develop biliary complications, especially in those with nondilated IHBDs. 12,13 However, these data are under controversial. 12 And, few studies have evaluated the role of PTBD in recipients with early biliary complications after LT, especially bile leaks.…”