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Survival benefit of percutaneous transhepatic biliary drainage for malignant biliary tract obstruction—a prospective study comparing external and internal drainage techniques

Abdominal Radiology volume 46, pages 5408–5416 (2021)Cite this article

Abstract

Purpose

To evaluate the clinical results of percutaneous transhepatic biliary drainage (PTBD) in patients with non-operable malignant biliary tract obstruction (MBTO) and the survival benefit of internal drainage.

Methods

Prospective data of consecutive patients of PTBD from May 2014 to August 2017 was analyzed for 30-day, 90-day and 1-year mortality, and mean survival of patients undergoing external drainage (ED) and internal drainage (ID) using internal–external ring biliary catheterization or biliary stent were compared. Other important variables evaluated were drop in the total bilirubin (TBil) levels, improvement in pain and pruritus, procedure-related complications, and patient satisfaction.

Results

In 87 cases (54 male, 33 female) with mean age 37.3 y (22–70 y; 95% CI: 31.1 y–43.5 y), 10, 45 and 32 patients underwent stenting, external and internal-external catheterization, respectively (total 152 procedures [> 1 in 35.63%, n = 31]). PTBD resulted in decrease in mean TBil by 8.2738 ± 0.912 mg/dL at 30 days (P < 0.001), 55.14% (n = 48) cases reaching 3 mg/dL at mean 45 days, and 35/48 cases received chemotherapy. Overall mortality was 6.89%, 37.93% and 90.80% at 30 days, 90 days and 1 year, respectively. Mean survival with ID (236.40 ± 33.37 days) was better than with ED (110.35 ± 26.16 days) (P < 0.001). Pain (62.06%; n = 54; mean Visual Analog Scale [VAS] score = 6.7) improved significantly (mean VAS score 3.4; P < 0.001). Pruritus (n = 29) was relieved in 100% of the cases. Complication rate of 18.39% (n = 16) and no procedure-related death were seen.

Conclusion

PTBD offers a safe and significant improvement in TBil, pain, and pruritus in non-operable MBTO, with ID offering additional survival benefit over ED.

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Data availability

The basic essential data that support the findings of this study are available in the supplementary file. Further data may be obtained from the corresponding author, upon reasonable request.

Code availability

Not applicable.

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Acknowledgements

The authors thank Dr Alok Ranjan, Department of Community and Family Medicine, Biostatistics section, for the statistical analysis, and Mr. Sanjeev Kumar, Radiographic Technician Grade 1 for record keeping and database maintenance.

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Authors and Affiliations

  1. Department of Radiodiagnosis, All India Institute of Medical Sciences Patna, Phulwarisharif, Patna, Bihar, 801507, India

    Subhash Kumar

  2. Department of Radiotherapy, All India Institute of Medical Sciences Patna, Phulwarisharif, Patna, Bihar, 801507, India

    Pritanjali Singh

  3. Department of General Surgery, All India Institute of Medical Sciences Patna, Phulwarisharif, Patna, Bihar, 801507, India

    Vinod Kumar & Manoj Kumar

  4. Department of Biochemistry, All India Institute of Medical Sciences Patna, Phulwarisharif, Patna, Bihar, 801507, India

    Mala Mahto

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  1. Subhash Kumar
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Correspondence to Subhash Kumar.

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Kumar, S., Singh, P., Kumar, V. et al. Survival benefit of percutaneous transhepatic biliary drainage for malignant biliary tract obstruction—a prospective study comparing external and internal drainage techniques. Abdom Radiol 46, 5408–5416 (2021). https://doi.org/10.1007/s00261-021-03215-4

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  • DOI: https://doi.org/10.1007/s00261-021-03215-4

Keywords

  • PTBD
  • Gall bladder carcinoma
  • Obstructive jaundice
  • Biliary obstruction