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To the Editor,
We thank the writers for their letter regarding our paper, “Predicting Success in Percutaneous Transhepatic Biliary Drainage.” As stated in our paper, we agree that percutaneous transhepatic biliary drainage (PTBD) often results in decreased bilirubin levels [1] and our findings match those of the referenced papers [2,3,4,5]. However, our paper examines the efficacy of PTBD in achieving a goal of a particular bilirubin level. For our study, we evaluated achieving levels less than 2 mg/dL as this is required for many chemotherapeutic regimens. The data suggest that certain patient populations are less likely to achieve a bilirubin less than 2 mg/dL despite successful PTBD placement. This does not mean that PTBD should no longer be performed nor do we doubt its efficacy in certain clinical settings. It is our hope that information on the likely decrease in bilirubin post-PTBD will allow patients and referring providers to better weigh the risks and benefits of the procedure. We agree with the letter writers that further studies are needed and data from other institutions to make the model more robust.
References
Khosla A, Xi Y, Toomay S. Predicting success in percutaneous transhepatic biliary drainage. Cardiovasc Intervent Radiol. 2017. doi:10.1007/s00270-017-1679-0
Moole H, Dharmapuri S, Duvvuri A, et al. Endoscopic versus percutaneous biliary drainage in palliation of advanced malignant hilar obstruction: a meta-analysis and systematic review. Can J Gastroenterol Hepatol. 2016;2016:4726078.
Saad WE, Wallace MJ, Wojak JC, Kundu S, Cardella JF. Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy. J Vasc Interv Radiol JVIR. 2010;21(6):789–95.
Saluja SS, Gulati M, Garg PK, et al. Endoscopic or percutaneous biliary drainage for gallbladder cancer: a randomized trial and quality of life assessment. Clin Gastroenterol Hepatol. 2008;6(8):944 e943–950 e943.
Zhao XQ, Dong JH, Jiang K, Huang XQ, Zhang WZ. Comparison of percutaneous transhepatic biliary drainage and endoscopic biliary drainage in the management of malignant biliary tract obstruction: a meta-analysis. Dig Endosc. 2015;27(1):137–45.
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Khosla, A., Xi, Y. & Toomay, S. Response to Letter. Cardiovasc Intervent Radiol 40, 1656 (2017). https://doi.org/10.1007/s00270-017-1743-9
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DOI: https://doi.org/10.1007/s00270-017-1743-9