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

Verma, Nikita; Hema, H K; Gupta, Pankaj; Kang, Mandeep; Kalra, Naveen; Samanta, Jayanta; Mandavdhare, Harshal; Sharma, Vishal; Dutta, Usha; Kochhar, Rakesh; Sandhu, Manavjit Singh

doi:10.1016/j.jceh.2021.09.002

Cited by 10 publications

(4 citation statements)

References 22 publications

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“…Patients who cannot tolerate ERCP should be treated promptly with percutaneous biliary drainage (PTCD) and aggressive conservative treatment. PTCD is a standard treatment for biliary drainage ( 28 , 29 ). We recommended patients who can tolerate ERCP can undergo rapid ERCP biliary stenting or nasobiliary implantation with later treatment of stones.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for complications in elderly patients aged 85 years and over undergoing endoscopic biliary stone removal

et al. 2022

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Background and aimThe number of elderly patients with biliary stones is increasing. Endoscopic retrograde cholangiography (ERCP) is considered to be an effective treatment for biliary stones. Having a sound knowledge of the risk factors can help reduce the incidence and severity of complications for ERCP. Furthermore, limited research has been published on patients aged over 85 years undergoing endoscopic biliary stone removal. This study aims to determine the risk factors that lead to complications of ERCP in patients over 85 years of age.MethodsThis was a single-center retrospective study. We analyzed 156 patients aged ≥ 85 years with biliary stones who underwent their first ERCP at Chinese PLA General Hospital from February 2002 to March 2021. Logistic regression models were employed to identify the independent risk factors for complications.ResultsA total of 13 patients (8.3%) had complications. Thereinto, pancreatitis, cholangitis, bleeding, and other complications occurred in 4 cases (2.6%), 1 cases (0.6%), 4 cases (2.6%), and 4 cases (2.6%), respectively. There was no perforation or death related to ERCP. Independent risk factors for complications were acute biliary pancreatitis (ABP) (P = 0.017) and Charlson Comorbidity Index (CCI) (P = 0.019). Significantly, reasons for incomplete stone removal at once were large stone (>10 mm) (P < 0.001) and higher acute physiology and chronic health evaluation scoring system (APACHE-II) (P = 0.005).ConclusionsERCP was recommended with caution in patients ≥ 85 years of age with ABP or higher CCI undergoing endoscopic biliary stone removal. In patients with ABP without cholangitis or biliary obstruction we recommend against urgent (within 48 h) ERCP. Patients with higher CCI who can tolerate ERCP can undergo rapid ERCP biliary stenting or nasobiliary implantation with later treatment of stones, and patients who cannot tolerate ERCP are treated promptly with PTCD and aggressive conservative treatment.

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Section: Discussionmentioning

confidence: 99%

Risk factors for complications in elderly patients aged 85 years and over undergoing endoscopic biliary stone removal

et al. 2022

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“…Возникновение такого осложнения, как механическая желтуха (МЖ), у больных со злокачественными новообразованиями гепатобилиопанкреатодуоденальной зоны (ГБПДЗ) и способы ее ликвидации в целях возможного проведения дальнейшего специального лечения являются одной из наиболее актуальных проблем в абдоминальной онкохирургии [1][2][3][4][5][6][7]. Наиболее частой локализацией опухоли, приводящей к развитию МЖ, является головка поджелудочной железы.…”

Section: оригинальные исследования введениеunclassified

Risk prediction program for choosing methods of biliary tract decompression in patients with obstructive jaundice caused by tumors: clinical testing

Васин¹,

Omelchenko

2023

Kreativnaâ hirurgiâ i onkologiâ

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Introduction. The most pressing problems in abdominal oncology surgery are the development of obstructive jaundice as a complication in patients with malignant tumors in the hepatobiliary and pancreatoduodenal area, and the ways to eliminate it and to reduce the risk of adverse events. Our earlier research revealed 14 predictors that together are more likely to cause undesirable postoperative complications, including deaths during minimally invasive biliary tract decompression. On the basis of the data obtained, a computer program “Risk Assessment of Treatment Methods for Obstructive Jaundice” was created.Materials and methods. The program was introduced into clinical practice in Yaroslavl Regional Clinical Oncology Hospital and was tested on 144 patients from 2019 through 2022. Th e program issued a conclusion on the risk of adverse events and assigned the patient to one of the groups where drainage or stenting were recommended for the first stage of biliary tract decompression.Results and discussion. Following a collegial decision based on the results obtained via the program, 58 patients (40.28 %) underwent endoscopic stenting and 86 patients (59.72 %) underwent percutaneous transhepatic biliary drainage. In the study group, adverse events developed in 10 patients (6.94 %), while in the control group — in 50 patients (22.94 %), and 134 patients (93.06 %) had no complications, as compared to 168 patients (77.06 %) in the control group.Conclusion. Application of the program based on reliable and practically significant 14 predictors results in a decline in general complications induced by minimally invasive biliary tract decompression from 22.94 % to 6.94 % and a 3.5-fold decrease in mortality from 5.05 % to 1.39 % in patients with malignant neoplasms in the hepatobiliary and pancreatoduodenal area, complicated by obstructive and mixed jaundice.

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“…The treatment of common bile duct stones has gradually transitioned from traditional open tor minimally invasive laparoscopic lithotomy to ERCP [6]. With the rapid development of ultrasound interventional technology, Percutaneous transhepatic gallbladder drainage is become a safe and effective treatment modality for patients with acute cholecystitis [7]. However, surgical intervention is still required for the treatment of common bile duct stones.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…However, surgical intervention is still required for the treatment of common bile duct stones. The current clinical success rate of PTGD is between 80% and 96%, and the complications rate after PTGD ranges between 4% to 17% [4][5][6][7][8]. The main complications after PTGD includes biliary bleeding, pneumothorax, biliary leakage, intra-abdominal abscess, intestinal perforation, drainage tube detachment, and duct blockage [8].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Single-operator cholangioscopy system for management of acute cholecystitis secondary to choledocholithiasis

Tao,

Wang,

Guo

2023

Endosc Int Open

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This study aimed to investigate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) + EyeMax (single-operator cholangioscopy system; SOC) (i.e., ERCP+SOC) for the treatment of choledocholithasis-associated acute cholecystitis. Twenty-five patients were evaluated between January 2022 and June 2023. The success rate (technical + clinical), procedure time, postoperative recovery, post-operative length of hospital stay, and complications rates were recorded. The procedure and clinical success rates were 92% (23 / 25) and 96% (24/25), respectively. The mean procedure time was 36.6 ± 10 minutes (standard deviation [SD]. The average post-operative hospitalization was 2 ± 0.8 days. No adverse event such as bleeding, perforation, or bile leakage occurred. Colecystitis did not recur during the 2 to 18 months of follow-up. ERCP+SOC may provide a feasible, safe, and effective alternative treatment for acute cholecystitis secondary to choledocholthiasis. ERCP+SOC was able to simultaneously resolved both biliary tract and the gallbladder problems via natural orifice endoscopy. Its advantage included no skin wound, reduced postoperative pain, quick recovery, limited to no exposure to x-rays, and a short hospital stay.

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

Cited by 10 publications

References 22 publications

Risk factors for complications in elderly patients aged 85 years and over undergoing endoscopic biliary stone removal

Risk factors for complications in elderly patients aged 85 years and over undergoing endoscopic biliary stone removal

Risk prediction program for choosing methods of biliary tract decompression in patients with obstructive jaundice caused by tumors: clinical testing

Single-operator cholangioscopy system for management of acute cholecystitis secondary to choledocholithiasis

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