Skip to main content

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

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.

Graphic abstract

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

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.

References

  1. Born P, Rosch ZT, Triptrap A, Frimberger E, Allesscher HD, Ott R, Weiert N, Lorenz R, Classen M (1998) Long-Term Results of Percutaneous Transhepatic Biliary Drainage for Benign and Malignant Bile Duct Strictures. Scand J Gastroenterol 33(5):544–549. https://doi.org/10.1080/00365529850172142

    CAS  Article  PubMed  Google Scholar 

  2. Nurick AW, Patey DH, Whiteside CG (1953) Percutaneous transhepatic cholangiography in the diagnosis of obstructive jaundice. Br J Surg 41(165): https://doi.org/10.1002/bjs.18004116509

    CAS  Article  PubMed  Google Scholar 

  3. Zhong SX (1981) Percutaneous transhepatic cholangiography (PTC) and bile drainage (PTCD): a report of 70 cases (author’s transl). Zhonghua Wai Ke Za Zhi 19(7): 387–390.

    CAS  PubMed  Google Scholar 

  4. Thornton RH, Ulrich R, Hsu M, Moskowitz C, Reidy-Lagunes D, Covey AM, Brody LA, Robson PM, Sofocleous CT, Solomon SB, Getrajdman GI, Brown KT (2012) Outcomes of patients undergoing percutaneous biliary drainage to reduce bilirubin for administration of chemotherapy. J Vasc Interv Radiol 23(1): 89–95. https://doi.org/10.1016/j.jvir.2011.09.022

    Article  PubMed  Google Scholar 

  5. Van Laethem JL, De Broux S, Eisendrath P, Cremer M, Le Moine O, Deviere J (2003) Clinical impact of biliary drainage and jaundice resolution in patients with obstructive metastases at the hilum. Am J Gastroenterol 98(6): 1271–127. https://doi.org/10.1111/j.1572-0241.2003.07504.x

    Article  PubMed  Google Scholar 

  6. Chandrashekhara SH, Gamanagatti S, Singh A, Bhatnagar S (2016) Current status of percutaneous transhepatic biliary drainage in palliation of malignant obstructive jaundice: A review. Indian J Palliat Care 22(4):378–387. https://doi.org/10.4103/0973-1075.191746

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  7. Gupta P, Maralakunte M, Rathee S, Samanta J, Sharma V, Mandavdhare H, Sinha SK, Dutta U, Kochhar R (2020) Percutaneous transhepatic biliary drainage in patients at higher risk for adverse events: experience from a tertiary care referral center. Abdom Radiol (NY) 45(8):2547–2553. https://doi.org/10.1007/s00261-019-02344-1

    Article  Google Scholar 

  8. Gupta P, Maralakunte M, Kalra N, Samanta J, Sharma V, Mandavdhare H, Dutta U, Kochhar R, Sandhu MS (2021) Feasibility and safety of bedside percutaneous biliary drainage in patients with severe cholangitis. Abdominal radiology (NY) 46(5), 2156–2160. https://doi.org/10.1007/s00261-020-02825-8

    Article  Google Scholar 

  9. Gupta P, Bansal V, Kalra N, Samanta J, Mandavdhare H, Sharma V, Dutta U, Kochhar R, Sandhu MS (2021) Should patients with unresectable gallbladder cancer with hilar involvement undergo unilateral or bilateral percutaneous biliary drainage in the setting of cholangitis? Clin Exp Hepatol. 7(1):7–12. https://doi.org/10.5114/ceh.2021.104674

    Article  PubMed  PubMed Central  Google Scholar 

  10. Sacks D, McClenny TE, Cardella JF, Lewis CA (2003) Society of Interventional Radiology Clinical Practice Guidelines. J Vasc Interv Radiol; 14:S199-S202. https://doi.org/10.1097/01.RVI.0000094584.83406.3e

    Article  PubMed  Google Scholar 

  11. Hawthorne G, Sansoni J, Hayes L, Marosszeky N, Sansoni E (2014) Measuring patient satisfaction with health care treatment using the Short Assessment of Patient Satisfaction measure delivered superior and robust satisfaction estimates. J Clin Epidemiol. 67(5):527–37. https://doi.org/10.1016/j.jclinepi.2013.12.010

    Article  PubMed  Google Scholar 

  12. van Delden OM, Lameris JS (2008) Percutaneous drainage and stenting for palliation of malignant bile duct obstruction. Eur Radiol 18: 448–456. https://doi.org/10.1007/s00330-007-0796-6

    Article  PubMed  Google Scholar 

  13. Garcarek J, Kurcz J, Guzinski M, Janczak D, Sasiadek M (2012) Ten years single center experience in percutaneous transhepatic decompression of biliary tree in patients with malignant obstructive jaundice. Adv Clin Exp Med 21: 621–632

    PubMed  Google Scholar 

  14. Zhao XQ, Dong JH, Jiang K, Huang XQ, Zhang WZ (2015) Comparison of percutaneous transhepatic biliary drainage and endoscopic biliary drainage in the management of malignant biliary tract obstruction: a meta-analysis. Dig Endosc. 27(1):137–45. https://doi.org/10.1111/den.12320

    Article  PubMed  Google Scholar 

  15. Crosara MAT, Mak MP, Maarques DF, Capareli-Azevedo FC, Hoff PN (2012) Percutaneous transhepatic biliary drainage (PTBD) in patients (pts) with advanced solid malignancies: Clinical outcomes and prognostic factors. Journal of Clinical Oncology 30(4_supl):312–315. https://doi.org/10.1200/jco.2012.30.4_suppl.315

    Article  Google Scholar 

  16. Tuqan W, Innabi A, Alawneh A, Farsakh FA, Al- Khatib M (2017) Prediction of survival following percutaneous biliary drainage for malignant biliary obstruction. J Transl Intern Med 5: 127–131. https://doi.org/10.1515/jtim-2017-0014

    Article  Google Scholar 

  17. Teixeira MC, Mak MP, Marques DF, Capareli F, Carnevale FC, Moreira AM, Ribeiro RJ, Cecconello I, Hoff PM (2013) Percutaneous transhepatic biliary drainage in patients with advanced solid malignancies: prognostic factors and clinical outcomes. J Gastrointest Cancer 44: 398–403. https://doi.org/10.1007/s12029-013-9509-3

    Article  Google Scholar 

  18. Kasuga A, Ishii H, Ozaka M, Matsusaka S, Chin K, Mizunuma N, Yukisawa S, Matsueda K, Furuse J (2012) Clinical outcome of biliary drainage for obstructive jaundice caused by colorectal and gastric cancers. Jpn J Clin Oncol 42(12):1161–1167. https://doi.org/10.1093/jjco/hys168

    Article  PubMed  Google Scholar 

  19. Zhang GY, Li WT, Peng WJ, Li GD, He XH, Xu LC (2014) Clinical outcomes and prediction of survival following percutaneous biliary drainage for malignant obstructive jaundice. Oncol Lett 7: 1185–1190. https://doi.org/10.3892/ol.2014.1860

    Article  PubMed  PubMed Central  Google Scholar 

  20. Knap D, Orlecka N, Judka R, Juza A, Drabek M, Honkowicz M, Kirmes T, Kadłubicki B, Sieron ́D, Baron J (2016) Biliary duct obstruction treatment with aid of percutaneous transhepatic biliary drainage. Alexandria Journal of Medicine 52, 185–191. https://doi.org/10.1016/j.ajme.2015.07.003

    Article  Google Scholar 

  21. Hong HP, Seo TS, Cha IH, Yu JR, Mok YJ, Oh JH, Kwon SH, Kim SS, Kim SK (2013) Percutaneous Placement of Self-Expandable Metallic Stents in Patients with Obstructive Jaundice Secondary to Metastatic Gastric Cancer after Gastrectomy. Korean J Radiol. 14(5):789–796. https://doi.org/10.3348/kjr.2013.14.5.789

    Article  PubMed  PubMed Central  Google Scholar 

  22. Shim DJ, Gwon DI, Han K, Kim Y, Ko GY, Shin JH, Ko HK, Kim JH, Kim JW, Yoon HK, Sung KB (2018) Percutaneous Metallic Stent Placement for Palliative Management of Malignant Biliary Hilar Obstruction. Korean J Radiol. 19(4):597–605. https://doi.org/10.3348/kjr.2018.19.4.597

    Article  PubMed  PubMed Central  Google Scholar 

  23. Furuse J, Takada T, Miyazaki M, Miyakawa S, Tsukada K, Nagino M, Kondo S, Saito H, Tsuyuguchi T, Hirata K, Kimura F, Yoshitomi H, Nozawa S, Yoshida M, Wada K, Amano H, Miura F (2008) Guidelines for chemotherapy of biliary tract and ampullary carcinomas. J Hepatobiliary Pancreat Surg 15: 55–62. https://doi.org/10.1007/s00534-007-1280-z

    Article  PubMed  PubMed Central  Google Scholar 

  24. Robson PC, Heffernan N, Gonen M, Thornton R, Brody LA, Holmes R, Brown KT, Covey AM, Fleischer D, Getrajdman GI, Jarnagin W, Sofocleous C, Blumgart L, D’Angelica M (2010) Prospective study of outcomes after percutaneous biliary drainage for malignant biliary obstruction. Ann Surg Oncol 17: 2303–2311. https://doi.org/10.1245/s10434-010-1045-9

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  25. Fairchild AH, Hihenwalter EJ, Gipson MG, Al-Refaie WB, Braun AR, Cash BD, Kim CY, Piunchot JW, Scheidt MJ, Schramm K, Sella DM, Weiss CR, Lorenz JM (2019) ACR Appropriateness Criteria® Radiologic Management of Biliary Obstruction. Journal of the American College of Radiology 16(5S): S196–S213. https://doi.org/10.1016/j.jacr.2019.02.020

    Article  PubMed  Google Scholar 

  26. Dy SM, Harman SM, Braun UK, Howie LJ, Harris PF, Jayes RL (2012) To stent or not to stent: an evidence-based approach to palliative procedures at the end of life. J Pain Symptom Manage 43(4):795–801. https://doi.org/10.1016/j.jpainsymman.2011.12.269

    Article  PubMed  Google Scholar 

  27. Zhang JX, Zu QQ, Liu S, Zhou CG, Xia JG, Shi HB (2018) Differences in efficacy of uncovered self-expandable metal stent in relation to placement in the management of malignant distal biliary obstruction. Saudi J Gastroenterol 24:82–86. https://doi.org/10.4103/sjg.SJG_326_17

    Article  PubMed  PubMed Central  Google Scholar 

  28. Venkatanarasimha N, Damodharan K, Gogna A, Leong S, Too CW, Patel A, Tay, KH, Tan BS, Lo R, Irani F (2017) Diagnosis and Management of Complications from Percutaneous Biliary Tract Interventions. Radiographics 37:665–680. https://doi.org/10.1148/rg.2017160159

    Article  PubMed  Google Scholar 

  29. Saad WE, Wallace MJ, Wojak JC, Kundu S, Cardella JF (2010) Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy. J Vasc Interv Radiol 21:789–795. https://doi.org/10.1016/j.jvir.2010.01.012

    Article  PubMed  Google Scholar 

  30. Weber A, Gaa J, Rosca B, Born P, Neu B, Schmid RM, Prinz C (2009) Complications of percutaneous transhepatic biliary drainage in patients with dilated and nondilated intrahepatic bile ducts. Eur J Radiol 72(3): 412–417. https://doi.org/10.1016/j.ejrad.2008.08.012

    Article  PubMed  Google Scholar 

  31. Gamanagatti S, Singh T, Sharma R, Srivastava DN, Dash NR, Garg PK (2016) Unilobar versus bilobar biliary drainage: effect on quality of life and bilirubin level reduction. Indian J Palliat Care 22(1):50–62. https://doi.org/10.4103/0973-1075.173958

    Article  PubMed  PubMed Central  Google Scholar 

  32. Chen JH, Sub CK, Liao CS, Chua CS (2006) Self-expandable metallic stents for malignant biliary obstruction: efficacy on proximal and distal tumors. World J Gastroenterol 12(1):119–122. https://doi.org/10.3748/wjg.v12.i1.119

    CAS  Article  PubMed  PubMed Central  Google Scholar 

Download references

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.

Funding

Not applicable.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Subhash Kumar.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The research work was done after due approval of the Institute Ethics Committee (IEC). The research work was carried out in accordance with principles outlined in the Helsinki Declaration, and the standard operating procedures of the IEC.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (xlsx 21 KB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

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

Keywords

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