Skip to main content

Advertisement

SpringerLink
Log in

Predicting Success in Percutaneous Transhepatic Biliary Drainage

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To develop a model to predict successful bilirubin decrease following percutaneous biliary drain placement.

Methods

A total of 257 patients who were identified having undergone percutaneous transhepatic biliary drain placement (PTBD) at our institution between 2002 and 2013 had their medical records and imaging reviewed. Of those, 190 of these patients met criteria and were used in the analysis. A regression model was performed on logarithm-transformed collected variables to predict post-drainage logarithmic transformed total bilirubin levels. A stepwise variable selection method based on Schwarz Bayesian Information Criterion was used to select the most closely associated variables. The model was validated with a Monte Carlo simulation. A short program was developed to calculate the point estimate using the model developed and compared to actual values.

Results

The variables that best predicted bilirubin reduction were initial Tbl (PrTbl), INR and ALT. The selected model had a root mean squared error of 0.8. The model had a negative predictive value (PoTbl is below 2 mg/dL) of 83%.

Conclusions

PTBD may not achieve decreasing bilirubin in patients with a malignant obstruction. This is an initial model that can help determine which patients may not benefit from PTBD placement. With more patients, the model’s validity can be increased and provide useful clinical determinant to aide patient care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ballinger AB, McHugh M, Catnach SM, Alstead EM, Clark ML. Symptom relief and quality of life after stenting for malignant bile duct obstruction. Gut. 1994;35(4):467–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Covey AM, Brown KT. Palliative percutaneous drainage in malignant biliary obstruction. J Support Oncol. 2006;4:269–73.

    PubMed  Google Scholar 

  3. Delden O, Laméris J. Percutaneous drainage and stenting for palliation of malignant bile duct obstruction. Eur Radiol. 2008;18(3):448–56.

    Article  PubMed  Google Scholar 

  4. Donelli MG, Zucchetti M, Munzone E, D’Incalci M, Crosignani A. Pharmacokinetics of anticancer agents in patients with impaired liver function. Eur J Cancer. 1998;34(1):33–46.

    Article  CAS  PubMed  Google Scholar 

  5. Dong II G, Gi-Young K, Kyu-Bo S, et al. Clinical outcomes after percutaneous biliary interventions in patients with malignant biliary obstruction caused by metastatic gastric cancer. Acta Radiol. 2012;53(4):422–9.

    Article  Google Scholar 

  6. Eklund JW, Trifilio S, Mulcahy MF. Chemotherapy dosing in the setting of liver dysfunction. Oncology. 2005;19(8):1057–63 (discussion 1063-1054, 1069).

  7. Green RM, Flamm S. AGA technical review on the evaluation of liver chemistry tests. Gastroenterology. 2002;123(4):1367–84. doi:10.1053/gast.2002.36061.

    Article  PubMed  Google Scholar 

  8. Kennedy TJ, Yopp A, Qin Y, et al. Role of preoperative biliary drainage of liver remnant prior to extended liver resection for hilar cholangiocarcinoma. HPB. 2009;11(5):445–51.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Levy JL, Sudheendra D, Dagli M, et al. Percutaneous biliary drainage effectively lowers serum bilirubin to permit chemotherapy treatment. Abdom Radiol. 2016;41(2):317–23.

    Article  Google Scholar 

  10. Mahgerefteh S, Hubert A, Klimov A, Bloom AI. Clinical impact of percutaneous transhepatic insertion of metal biliary endoprostheses for palliation of jaundice and facilitation of chemotherapy. Am J Clin Oncol. 2015;38(5):489–94.

    Article  Google Scholar 

  11. Najafabadi MM, Villanustre F, Khoshgoftaar TM, Seliya N, Wald R, Muharemagic E. Deep learning applications and challenges in big data analytics. J Big Data. 2015;2(1):1–21.

    Article  Google Scholar 

  12. Robson PC, Heffernan N, Gonen M, et al. Prospective study of outcomes after percutaneous biliary drainage for malignant biliary obstruction. Ann Surg Oncol. 2010;17(9):2303–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Thornton RH, Ulrich R, Hsu M, et al. Outcomes of patients undergoing percutaneous biliary drainage to reduce bilirubin for administration of chemotherapy. J Vasc Interv Radiol. 2012;23(1):89–95.

    Article  PubMed  Google Scholar 

  14. Tsai H, Chiao-Hsiung C, Xi-Zhang L. Factors relating to the short term effectiveness of percutaneous biliary drainage for hilar cholangiocarcinoma. World J Gastroenterol. 2009;15(41):5206–10.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Venook AP, Egorin MJ, Rosner GL, et al. phase i and pharmacokinetic trial of gemcitabine in patients with hepatic or renal dysfunction: Cancer and Leukemia Group B 9565. J Clin Oncol. 2000;18(14):2780–7.

    Article  CAS  PubMed  Google Scholar 

  16. Weston BR, Ross WA, Wolff RA, et al. Rate of bilirubin regression after stenting in malignant biliary obstruction for the initiation of chemotherapy. Cancer. 2008;112(11):2417–23.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, University of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA

    Ankaj Khosla, Yin Xi & Seth Toomay

Authors
  1. Ankaj Khosla
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yin Xi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seth Toomay
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seth Toomay.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical Approval

For this type of study, formal consent is not required.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 87 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khosla, A., Xi, Y. & Toomay, S. Predicting Success in Percutaneous Transhepatic Biliary Drainage. Cardiovasc Intervent Radiol 40, 1586–1592 (2017). https://doi.org/10.1007/s00270-017-1679-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-017-1679-0

Keywords

Search

Navigation