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Eur Radiol (2011) 21:19481955 DOI 10.1007/s00330-011-2121-7
INTERVENTIONAL
Percutaneous transhepatic biliary drainage (PTBD) with or without stentingcomplications, re-stent rate and a new risk stratification score
C. R. Tapping & O. R. Byass & J. E. I. Cast
Received: 1 November 2010 /Revised: 12 January 2011 /Accepted: 21 February 2011 /Published online: 1 May 2011 # European Society of Radiology 2011
AbstractObjectives To review the success rate and number of complications in patients with obstructive jaundice treated with percutaneous transhepatic biliary drainage (PTBD), and to stratify the procedural risk of both PTBD and biliary stenting.
Subjects and Methods 948 procedures performed in 704 consecutive patients with obstructive jaundice over a 7 year period were reviewed: 345 male; 359 females, mean age 70.1 years (range 4896 years). Statistical analysis included X2 test and multivariate logistic regression analysis.
Results The technical success rate was 99%. The mortality related to the procedure was 2% and the 30-day mortality 13%. 91 (13%) stents inserted occluded during the study period. Predictors for stent failure and re-stenting were a diagnosis of cholangiocarcinoma, a lesion in the distal CBD, a high bilirubin, high urea and high white cell count and post procedure cholangitis. Factors significantly related to complications and 30-day mortality were retrospectively reviewed to devise a risk stratification score.
Conclusions PTBD and stenting offer a safe and effective method in providing palliative treatment for patients with biliary obstruction. Patients likely to have high levels of morbidity and mortality can be predicted before PTBD, using a risk stratification score, highlighting the need for closer clinical observation and delayed stent placement.
Keywords Percutaneous transhepatic biliary drainage (PTBD) . Biliary stent . Hepatobiliary disease . Risk stratification
Introduction
Percutaneous transhepatic biliary drainage (PTBD) is effective in the management of biliary obstruction [1, 2]. The cause of obstruction can be benign or malignant. Malignant biliary obstruction is commonly due to pancreatic carcinoma, cholangiocarcinoma, or metastatic disease. Other causes include gall bladder carcinoma, hepatocellular carcinoma, lymphoma, and advanced gastric or duodenal cancer. In patients with obstructive jaundice, PTBD and/or stenting plays an important role in their overall management. Drainage or stenting of an obstruction can relieve symptoms and restore serum biochemistry to normal. This optimizes the clinical condition of the patients for surgical resection or for receiving palliative...