Abstract
Objectives
This study was designed to audit current practice in percutaneous biliary drainage and stenting in the United Kingdom.
Methods
In 2006, the British Society of Interventional Radiology set up the first web-based Biliary Drainage and Stenting Registry (BDSR). This consisted of a series of tick sheets, which were completed online. Data collection included technical and clinical success of the procedures and outcomes at discharge with a separate form for any follow-up visits. Two months before data analysis, all contributors were asked via email to complete any outstanding data. This paper reports on data collected between November 1, 2006 and August 18, 2009.
Results
A total of 833 procedures were recorded and were entered by 62 operators from 44 institutions within the United Kingdom. There were 455 men and 378 women with a median age of 69 (range 20–101) years.The majority of procedures were performed by a consultant. Successful drainage of the biliary tree was achieved in 98.7%. Partial or complete relief of symptoms was seen in 65% of patients. Minor complications, predominantly pain (14.3%), were seen in 26% and major complications, predominantly sepsis (3.5%), were seen in 7.9% of patients.
Conclusions
These figures provide an essential benchmark for both audit and patient information. Identifying areas of good practice and those that require improvement will ultimately result in better patient care.
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Notes
Number in brackets is the number of patients entered into the registry.
References
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Authors declare there is no conflict of interests.
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R. Uberoi, N. Das, J. Moss and I. Robertson on behalf of the biliary registry contributors
Appendices
Appendix 1
See Fig. 4
Appendix 2
Definitions
- Ascites:
-
mild/moderate <10-mm depth over right liver
Gross >10-mm depth over right liver
- Biliary dilatation:
-
Mild/Moderate: Peripheral ducts just visible, CBD >8–15 mm<
Marked: Peripheral ducts grossly dilated or >2 mm and or CBD >15 mm
- Obstruction:
-
No immediate contrast passage at direct injection into the biliary tree at ERCP or PTC
- Stricture:
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>50% luminal reduction of the duct
- Technically successful drainage:
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Placement of drain into the biliary tree and external/internal free flow of bile
- Technically successful stent:
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Placement of stent/s in intended position with free passage of bile into the duodenum
- Primary stent:
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Stent placed at the time of initial drainage procedure
- Staged stent:
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Stent placed after initial drainage procedure
- Combined:
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Stent placed with endoscopic assistance
- Bilateral stent:
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Stents placed from a right and left biliary duct approach
- Sepsis:
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Defined by the presence of two or more of the following
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Body temperature <36°C (97°F) or >38°C (100°F) (hypothermia or fever).
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Heart rate >100 beats per minute (tachycardia).
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Respiratory rate >20 breaths per minute or, on blood gas, PaCO2 <32 mmHg (4.3 kPa) (tachypnea or hypocapnia due to hyperventilation).
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White blood cell count <4,000 cells/mm3 or >12,000 cells/mm3 (<4 × 109 or >12 × 109 cells/l), or >10% band forms (immature white blood cells) (leukopenia, leukocytosis, or bandemia).
- Hemorrhage:
-
bleeding from the access site
- Hematoma:
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Excludes simple skin discoloration
Mild: Not requiring transfusion
Moderate: Requires transfusion
Severe: Transfusion and intervention surgical/endovascular
- Re-intervention:
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Unplanned additional procedure after initial drainage and/or stenting episode
- Functional patency:
-
Relief of symptoms
Complications
Clinical Outcome Following a Complication
Minor (No Clinical Consequence)
-
a.
No therapy, e.g., small hematoma
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b.
Minimal therapy management of a vasovagal attack or contrast reaction, or <24 h admission for observation
Major (Significant Patient Consequence Requiring Therapy)
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c.
Unplanned hospitalization >24 to <48 h, e.g., for transfusion
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d.
Unplanned hospitalization >48 h, e.g., surgical bypass graft
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e.
Permanent adverse sequelae
-
f.
Death
Renal Impairment
A deterioration in renal function detected within 10 days of the procedure, indicated by a 25% increase in creatinine level over baseline.
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Uberoi, R., Das, N., Moss, J. et al. British Society of Interventional Radiology: Biliary Drainage and Stenting Registry (BDSR). Cardiovasc Intervent Radiol 35, 127–138 (2012). https://doi.org/10.1007/s00270-011-0103-4
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DOI: https://doi.org/10.1007/s00270-011-0103-4