Skip to main content

Advertisement

SpringerLink
Log in

Percutaneous transhepatic biliary drainage (PTBD) with or without stenting—complications, re-stent rate and a new risk stratification score

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To review the success rate and number of complications in patients with obstructive jaundice treated with percutaneous transhepatic biliary drainage (PTBD), and to stratify the procedural risk of both PTBD and biliary stenting.

Subjects and Methods

948 procedures performed in 704 consecutive patients with obstructive jaundice over a 7 year period were reviewed: 345 male; 359 females, mean age 70.1 years (range 48–96 years). Statistical analysis included X 2 test and multivariate logistic regression analysis.

Results

The technical success rate was 99%. The mortality related to the procedure was 2% and the 30-day mortality 13%. 91 (13%) stents inserted occluded during the study period. Predictors for stent failure and re-stenting were a diagnosis of cholangiocarcinoma, a lesion in the distal CBD, a high bilirubin, high urea and high white cell count and post procedure cholangitis. Factors significantly related to complications and 30-day mortality were retrospectively reviewed to devise a risk stratification score.

Conclusions

PTBD and stenting offer a safe and effective method in providing palliative treatment for patients with biliary obstruction. Patients likely to have high levels of morbidity and mortality can be predicted before PTBD, using a risk stratification score, highlighting the need for closer clinical observation and delayed stent placement.

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

Similar content being viewed by others

References

  1. Schumacher B, Othman T, Jansen M, Preiss C, Neuhaus H (2001) Long-term follow-up of percutaneous transhepatic therapy (PTT) in patients with definite benign anastomotic strictures after hepaticojejunostomy. Endoscopy 33:409–415

    Article  PubMed  CAS  Google Scholar 

  2. Kim JH, Lee SK, Kim MH, Song MH, Park DH, Kim SY, Lee SS, Seo DW, Bae JS, Kim HJ, Han J, Sung KB, Min YI (2003) Percutaneous transhepatic cholangioscopic treatment of patients with benign bilio-enteric anastomotic strictures. Gastrointest Endosc 58:73373–73378

    Google Scholar 

  3. Mueller PR, van Sonnenberg E, Ferrucci JT Jr (1982) Percutaneous biliary drainage: technical and catheter-related problems in 200 procedures. AJR Am J Roentgenol 138:17–23

    PubMed  CAS  Google Scholar 

  4. Yee AC, Ho CS (1987) Complications of percutaneous biliary drainage: benign vs malignant diseases. AJR Am J Roentgenol 148:1207–1209

    PubMed  CAS  Google Scholar 

  5. Clark RA, Mitchell SE, Colley DP, Alexander E (1981) Percutaneous catheter biliary decompression. AJR Am J Roentgenol 137:503–509

    PubMed  CAS  Google Scholar 

  6. Carrasco CH, Zornoza J, Bechtel WJ (1984) Malignant biliary obstruction: complications of percutaneous biliary drainage. Radiology 152:343–346

    PubMed  CAS  Google Scholar 

  7. Arner O, Hagsberg S, Seldinger SI (1962) Percutaneous transhepatic cholangiography: puncture of dilated and non dilated bile ducts under roentgen television control. Surgery 52:561–571

    Google Scholar 

  8. Kaude JV, Weidenmie CH, Agee OF (1969) Decompression of bile ducts with the percutaneous transhepatic technique. Radiology 93:69–71

    PubMed  CAS  Google Scholar 

  9. Molnar W, Stockum AE (1974) Relief of obstructive jaundice through percutaneous transhepatic catheter. A new therapeutic method. AJR Am J Roentgenol 122:356–367

    CAS  Google Scholar 

  10. Lameris JS, Obertop H, Jeekel J (1985) Biliary drainage by ultrasound-guided puncture of the left hepatic duct. Clin Radiol 36:269–274

    Article  PubMed  CAS  Google Scholar 

  11. Lammer J, Hausegger KA, Fluckiger F, Winkelbauer FW, Wildling R, Klein GE, Thruner SA, Havelec L (1996) Common bile duct obstruction due to malignancy: treatment with plastic versus metal stents. Radiology 201:167–172

    PubMed  CAS  Google Scholar 

  12. Hausegger KA, Thrunher S, Bodendorfer G, Zollkofer CL, Uggowitzer M, Kugler C, Lammer J (1998) Treatment of malignant biliary obstruction with polyurethane-covered Wallstents. AJR Am J Roentgenol 170:403–408

    PubMed  CAS  Google Scholar 

  13. Schoder M, Rossi P, Uflacker R, Bezzi M, Stadler A, Funovics MA, Cejna M, Lammer J (2002) Malignant biliary obstruction: treatment with ePTFE-FEP-covered endoprosthesis initial technical and clinical experiences in a multicenter trial. Radiology 225:35–42

    Article  PubMed  Google Scholar 

  14. Miyayama S, Matsui O, Akakura Y, Yamamoto T, Nishida H, Yoneda K, Kawai K, Toya D, Tanaka N, Mitsui T, Asada Y (2004) Efficacy of covered metallic stents in the treatment of unresectable malignant biliary obstruction. Cardiovasc Intervent Radiol 27:349–354

    PubMed  Google Scholar 

  15. Schmassmann A, von Gunten E, Knuchel J, Scheurer U, Fehr HF, Halter F (1996) Wallstents versus plastic stents in malignant biliary obstruction: effets of stent patency of the first and second stent on patient compliance and survival. Am J Gastroenterol 91:654–659

    PubMed  CAS  Google Scholar 

  16. van Delden OM, Lameris JS (2008) Percutaneous drainage and stenting for palliation of malignant bile duct obstruction. Eur Radiol 18:448–456

    Article  PubMed  Google Scholar 

  17. Indar AA, Lobo DN, Gilliam AD, Gregson R, Davidson I, Whittaker S, Doran J, Rowlands BJ, Beckingham IJ (2003) Percutaneous biliary metal wall stenting in malignant obstructive jaundice. Eur J Gastroenterol Hepatol 15:915–919

    Article  PubMed  Google Scholar 

  18. Lee MJ, Dawson SL, Mueller PR, Saini S, Hahn PF, Goldberg MA, Lu DS, Mayo-Smith WW (1993) Percutaneous management of hilar biliary malignancies with metallic endoprostheses: results, technical problems and cause of failure. Radiographics 12:1249–1263

    Google Scholar 

  19. Inal M, Akgul E, Aksungur E, Demeiryrek H, Yagmur O (2003) Percutaneous placement of biliary metallic stents in patients with malignant hilar obstruction: unilobar versus bilobar drainage. J Vasc Interv Radiol 14:1409–1416

    PubMed  Google Scholar 

  20. Chang W, Kortan P, Haber GB (1998) Outcome in patients with bifurcation tumours who undergo unilateral versus bilateral hepatic duct. Gastrointest Endosc 47:354–362

    Article  PubMed  CAS  Google Scholar 

  21. Cowling MG, Adam AN (2001) Internal stenting in malignant biliary obstruction. World J Surg 25:355–361

    Article  PubMed  CAS  Google Scholar 

  22. Rerknimitr R, Kldadcharoen N, Mahachai V, Kullavanjaya P (2004) Result of endoscopic biliary drainage in hilar cholangiocarcinoma. J Clin Gastroenterol 38:518–523

    Article  PubMed  Google Scholar 

  23. Ong TC, Khor JL, Selamat DS, Yeoh KG, Ho KY (2005) Complications of endoscopic retrograde cholangiography in the post MRCP-era: a tertiary center experience. World J Gastroenterol 11:5209–5212

    PubMed  Google Scholar 

Download references

Acknowledgements

Thanks to Dr Victoria Allgar (Hull and York Medical School) for her assistance in statistical analysis of the data. This study was presented at ECR 2011.

Author information

Authors and Affiliations

  1. Department of Radiology, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK

    C. R. Tapping, O. R. Byass & J. E. I. Cast

Authors
  1. C. R. Tapping
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. O. R. Byass
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. E. I. Cast
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to O. R. Byass.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tapping, C.R., Byass, O.R. & Cast, J.E.I. Percutaneous transhepatic biliary drainage (PTBD) with or without stenting—complications, re-stent rate and a new risk stratification score. Eur Radiol 21, 1948–1955 (2011). https://doi.org/10.1007/s00330-011-2121-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-011-2121-7

Keywords

Search

Navigation