Quality Improvement Guidelines for Percutaneous Transhepatic Cholangiography, Biliary Drainage, and Percutaneous Cholecystostomy

Saad, Wael E.A.; Wallace, Michael J.; Wojak, Joan C.; Kundu, Sanjoy; Cardella, John F.

doi:10.1016/j.jvir.2010.01.012

Cited by 304 publications

(223 citation statements)

References 64 publications

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“…As stated in our paper, we agree that percutaneous transhepatic biliary drainage (PTBD) often results in decreased bilirubin levels [1] and our findings match those of the referenced papers [2][3][4][5]. However, our paper examines the efficacy of PTBD in achieving a goal of a particular bilirubin level.…”

supporting

confidence: 82%

Response to Letter

Khosla

Toomay

2017

Cardiovasc Intervent Radiol

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We thank the writers for their letter regarding our paper, ''Predicting Success in Percutaneous Transhepatic Biliary Drainage.'' As stated in our paper, we agree that percutaneous transhepatic biliary drainage (PTBD) often results in decreased bilirubin levels [1] and our findings match those of the referenced papers [2][3][4][5]. However, our paper examines the efficacy of PTBD in achieving a goal of a particular bilirubin level. For our study, we evaluated achieving levels less than 2 mg/dL as this is required for many chemotherapeutic regimens. The data suggest that certain patient populations are less likely to achieve a bilirubin less than 2 mg/dL despite successful PTBD placement. This does not mean that PTBD should no longer be performed nor do we doubt its efficacy in certain clinical settings. It is our hope that information on the likely decrease in bilirubin post-PTBD will allow patients and referring providers to better weigh the risks and benefits of the procedure. We agree with the letter writers that further studies are needed and data from other institutions to make the model more robust. Compliance with Ethical StandardsConflict of interest The authors declare that they have no conflict of interest. References1. Khosla A, Xi Y, Toomay S. Predicting success in percutaneous transhepatic biliary drainage.

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supporting

confidence: 82%

Response to Letter

Khosla

Toomay

2017

Cardiovasc Intervent Radiol

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“…While percutaneous biliary drainage (PBD) catheter insertion has been shown to be an effective and safe method for decompressing an obstructed biliary tree (5), the presence of metastatic disease of the liver can impose particular challenges. Multifocal biliary obstruction can be difficult or impossible to adequately drain with a reasonable number of catheters.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous biliary drainage catheter insertion in patients with extensive hepatic metastatic tumor burden

Langman¹,

Suhocki²,

Hurwitz³

et al. 2016

J. Gastrointest. Oncol.

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Laboratory data before and after PBD insertion were compared. Survival and outcomes analysis performed.A subanalysis was performed on patients with CT-demonstrated catheter traversal of tumoral tissue.Results: A PBD catheter was successfully inserted in all patients. The mean serum bilirubin level decreased significantly from 10.9±6.4 mg/dL immediately prior to PBD insertion to 7.1±5.6 mg/dL (P<0.001) within one month post PBD insertion. Four patients (11%) demonstrated normalization of bilirubin levels to less than 1.6 mg/dL. Of the 14 patients with a post-procedure CT or MRI, the PBD catheter traversed a tumor in 11 (79%). One of these patients required a transfusion after the procedure and one had recurrent catheter exchanges due to pericatheter leakage. The 30-day overall survival was 41% with a median survival of 19 days.The percentage decrease in serum bilirubin after PBD insertion and pre-procedure international normalized ratio (INR) were correlated with improved survival (OR =3.7, P=0.010 and OR =4.9, P=0.028 respectively).The PBD-associated major complication rate was 16%. Conclusions:In patients with hyperbilirubinemia and extensive hepatic metastatic disease burden, survival was dismal after PBD catheter insertion. Serum bilirubin level normalization occurred rarely.

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“…Severe complications following PTBD including peritonitis, sepsis, bleeding requiring re-intervention, and even procedure-related mortality have been well described [9,10] . Indeed, The Society of Interventional Radiology (SIR) quality improvement guidelines established the procedural risk of severe major complications at 2.5% [11] . Embolization of biliary tracts using different materials including gel foam, fibrin glue, n-butyl cyanoacrylate and endocoils are routinely used in clinical practice at the time when biliary catheters are removed, in order to reduce the risk of bile leakage or bleeding.…”

Section: Discussionmentioning

confidence: 99%

Endocoil placement after endoscopic ultrasound-guided biliary drainage may prevent a bile leak

Merwe

Omoshoro-Jones²,

Sanyika³

2013

WJGE

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AIM:To further reduce the risk of bleeding or bile leakage. METHODS:We performed endoscopic ultrasound guided biliary drainage in 6 patients in whom endoscopic retrograde cholangiopancreatography (ERCP) had failed. Biliary access of a dilated segment 2 or 3 duct was achieved from the stomach using a 19G needle. After radiologically confirming access a guide wire was placed, a transhepatic tract created using a 6 Fr cystotome followed by balloon dilation of the stricture and antegrade metallic stent placement across the malignant obstruction. This was followed by placement of an endocoil in the transhepatic tract. RESULTS:Dilated segmental ducts were observed in all patients with the linear endoscopic ultrasound scope from the proximal stomach. Transgastric biliary access was obtained using a 19G needle in all patients. Biliary drainage was achieved in all patients. Placement of an endocoil was possible in 5/6 patients. All patients responded to biliary drainage and no complications occurred. CONCLUSION:We show that placing endocoils at the time of endoscopic ultrasound guided biliary stenting is feasible and may reduce the risk of bleeding or bile leakage.

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Quality Improvement Guidelines for Percutaneous Transhepatic Cholangiography, Biliary Drainage, and Percutaneous Cholecystostomy

Cited by 304 publications

References 64 publications

Response to Letter

Response to Letter

Percutaneous biliary drainage catheter insertion in patients with extensive hepatic metastatic tumor burden

Endocoil placement after endoscopic ultrasound-guided biliary drainage may prevent a bile leak

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