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Background: Post-cholecystectomy bile duct injuries (BDIs) represent a challenging complication, with negative impacts on clinical outcomes. Several surgical and endoscopic/interventional radiologist (IR) approaches have been proposed to manage these damages, though with high failure rates. This individual patient data (IPD) systematic review analyzes the potential risk factors for failure after treatment interventions for BDIs, both surgical and endoscopic/IR. Methods: An extensive literature search was conducted on MEDLINE and Scopus for relevant articles published in English on the management of BDIs after cholecystectomy, between 1 January 2010 and 31 December 2023. Our series of BDIs was included. BDIs were always categorized according to the Strasberg's classification. The composite primary endpoints evaluated were the failure of treatment interventions, defined as patient death or the requirement of any other procedure, whatever surgical and/or endoscopic/IR, after the primary treatment. Results: A total of 342 cases were retrieved from our literature analysis, including our series of 19 patients. Among these, three groups were identified: "upfront surgery", "upfront endoscopy and/or IR" and "no upfront treatment", consisting of 224, 109 and 9 patients, respectively. After eliminating the third group, treatment intervention failure was observed overall in 34.2% (114/333) of patients, of whom 80.7% (92/114) and 19.3% (22/114) in the "upfront surgery" and in the "upfront endoscopy/IR" groups, respectively. At multivariable analysis, injury type D and E, and repair in a non-specialized center represented independent predictors of treatment failure in both groups, whereas laparoscopic cholecystectomy (LC) converted to open and immediate attempt of surgical repair exclusively in the first group. Conclusions: Significant treatment failure rates are responsible for remarkable negative effects on immediate and longer-term clinical outcomes of post-cholecystectomy BDIs. Understanding the important risk factors for this outcome may better guide the most appropriate therapeutical approach and improve clinical decisions in case this serious complication occurs. [ABSTRACT FROM AUTHOR]

The infection of dipterous larvae causes myiasis. It is generally associated with unsanitary conditions. An interventional radiologist rarely comes across myiasis. We report a case of myiasis around a percutaneous transhepatic biliary drainage (PTBD) tube. A 31-year-old man from a rural area underwent left PTBD for cholangiocarcinoma and was discharged with an internal–external drain. Two weeks later, he presented with pain in the local site, pruritus, and bile leakage. He was found to have maggots around the PTBD tube with poor wound hygiene. Treatment included turpentine oil instillation and oral and topical ivermectin, accompanied by manual removal of the larva. [ABSTRACT FROM AUTHOR]

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for their analgesic and anti-inflammatory effects but can lead to serious gastrointes complications. This report illustrates the management of an NSAID-induced penetrating gastric ulcer with subsequent postoperative hemorrhagic cholecystitis. A 68-year-old female with chronic NSAID use presented with epigastric pain and was diagnosed with a penetrating gastric ulcer extending into the retroperitoneum. The surgical management required a shift from a minimally invasive robotic-assisted approach to an open procedure due to unexpected intraoperative findings. The postoperative period was notable for the development of hemorrhagic cholecystitis that was managed with percutaneous transhepatic biliary drainage, highlighting the role of interventional radiology in complex postoperative care. NSAID use significantly increases gastrointestinal risks, leading to complications such as ulcers that may penetrate into adjacent structures, including the retroperitoneum. The management of penetrating gastric ulcers typically involves complex surgical procedures, highlighted in this scenario by the necessity for an antrectomy followed by a Billroth II reconstruction to address the extensive damage and restore gastrointestinal continuity, which is essential for patient recovery. In this case, the development of hemorrhagic cholecystitis postoperatively was effectively managed with a percutaneous transhepatic biliary drain, demonstrating the importance of interventional radiology in managing postoperative complications and the need for a multidisciplinary approach. This case report elucidates the management of NSAID-induced penetrating gastric ulcer that extended into the retroperitoneum, necessitating an antrectomy with Billroth II reconstruction. A gastric ulcer is generally classified as ''large'' if it exceeds 2 centimeters in diameter. These ulcers pose greater risks of complications such as perforation, penetration into adjacent organs, bleeding, and obstruction, necessitating more complex and comprehensive management strategies. The postoperative complication of hemorrhagic cholecystitis was effectively managed via interventional radiology, highlighting the critical role of minimally invasive techniques in addressing severe postoperative complications.

The infection of dipterous larvae causes myiasis. It is generally associated with unsanitary conditions. An interventional radiologist rarely comes across myiasis. We report a case of myiasis around a percutaneous transhepatic biliary drainage (PTBD) tube. A 31-year-old man from a rural area underwent left PTBD for cholangiocarcinoma and was discharged with an internal–external drain. Two weeks later, he presented with pain in the local site, pruritus, and bile leakage. He was found to have maggots around the PTBD tube with poor wound hygiene. Treatment included turpentine oil instillation and oral and topical ivermectin, accompanied by manual removal of the larva.

Percutaneous transhepatic biliary drainage is a well-established technique for the treatment of biliary obstruction in patients with failed endoscopic approaches. We report on an 82-year-old man with a history of cholangiocarcinoma treated with pancreaticoduodenectomy who presented with recurrent cholangitis and sepsis. Percutaneous transhepatic biliary drainage was performed after unsuccessful endoscopic retrograde cholangiography, which initially improved his condition. However, due to an accidental dislodgement, there was an intra-abdominal fracture of the drain which led to biliary peritonitis and clinical deterioration. The fractured intrahepatic drain was successfully extracted in our angio suite, and a novel subcutaneous fixation technique was introduced to prevent similar occurrences in the future. This case study signifies the role of interventional radiology in the management of percutaneous transhepatic biliary drainage complications and the importance of preventative measures to avoid dislodgement.

Abstract The main cause of distal biliary malignant obstructive jaundice (DBMOJ) is the stricture of the extrahepatic biliary tract by malignant tumors, including pancreatic head and uncinate process cancer, low-grade cholangiocarcinoma, duodenal cancer, papillary duodenal cancer and other malignant tumors. The most effective treatment is radical pancreaticoduodenectomy. However, preoperative obstructive jaundice can affect the patient’s liver function and blood coagulation function, increase local inflammation and oedema, and make surgery more difficult. Patients with severe obstructive jaundice require preoperative biliary drainage, which can be achieved by various methods, including ultrasound endoscopic biliary drainage (EUS-EBD) and endoscopic retrograde biliary drainage (ERBD). The latter is mainly divided into endoscopic nasobiliary drainage and endoscopic biliary stent. Some patients underwent percutaneous transhepatic biliary drainage (PTBD) when ERBD and EUS-EBD failed. In this study, we aimed to identify PTBD in DBMOJ and to further investigate the role of the puncture pathway in DBMOJ. The relationship between PTBD and bile duct internal diameter was confirmed by analysing and collating clinical data. In this study, DBMOJ was grouped according to bile duct internal diameter and liver function was used as an indicator to examine the improvement in liver function with PTBD in patients undergoing DBMOJ. Analysis of puncture complications showed that PTBD puncture was safe. DBMOJ with different bile duct internal diameters had different rates of liver function improvement after PTBD. The right-side approaches had significantly lower alanine aminotransferase (ALT) and alanine transaminase (AST) than the left-side approaches. This study showed that PTBD for DBMOJ is associated with a low complication rate and good reduction of jaundice. Liver function recovery was faster in patients with DBMOJ treated with PTBD in the right-sided approach compared with the left-sided approach. PTBD is an effective tool to be used in patients who have failed ERBD and EUS-EBD.

The main cause of distal biliary malignant obstructive jaundice (DBMOJ) is the stricture of the extrahepatic biliary tract by malignant tumors, including pancreatic head and uncinate process cancer, low-grade cholangiocarcinoma, duodenal cancer, papillary duodenal cancer and other malignant tumors. The most effective treatment is radical pancreaticoduodenectomy. However, preoperative obstructive jaundice can affect the patient's liver function and blood coagulation function, increase local inflammation and oedema, and make surgery more difficult. Patients with severe obstructive jaundice require preoperative biliary drainage, which can be achieved by various methods, including ultrasound endoscopic biliary drainage (EUS-EBD) and endoscopic retrograde biliary drainage (ERBD). The latter is mainly divided into endoscopic nasobiliary drainage and endoscopic biliary stent. Some patients underwent percutaneous transhepatic biliary drainage (PTBD) when ERBD and EUS-EBD failed. In this study, we aimed to identify PTBD in DBMOJ and to further investigate the role of the puncture pathway in DBMOJ. The relationship between PTBD and bile duct internal diameter was confirmed by analysing and collating clinical data. In this study, DBMOJ was grouped according to bile duct internal diameter and liver function was used as an indicator to examine the improvement in liver function with PTBD in patients undergoing DBMOJ. Analysis of puncture complications showed that PTBD puncture was safe. DBMOJ with different bile duct internal diameters had different rates of liver function improvement after PTBD. The right-side approaches had significantly lower alanine aminotransferase (ALT) and alanine transaminase (AST) than the left-side approaches. This study showed that PTBD for DBMOJ is associated with a low complication rate and good reduction of jaundice. Liver function recovery was faster in patients with DBMOJ treated with PTBD in the right-sided approach compared with the left-sided approach. PTBD is an effective tool to be used in patients who have failed ERBD and EUS-EBD. [ABSTRACT FROM AUTHOR]

Background: Patients with percutaneous transhepatic biliary drainage (PTBD) need regular drainage tube care after discharge, and transitional care can help solve this problem. However, few studies have focused on the quality of transitional care, the perceptions of patients with drainage tubes after discharge and those of healthcare professionals. Aim: This study is aimed at exploring the real experience and perceptions of transitional care services among healthcare professionals and PTBD patients who have been discharged with tubes and at providing references for future transitional care service development. Design: The study uses a qualitative descriptive design. The reporting method followed Consolidated Criteria for Reporting Qualitative Research guidelines. Methods: Semistructured interviews were conducted with PTBD patients who had been discharged with tubes and multicentre healthcare professionals using the purpose sampling method. The thematic analysis method was used for analysis. Results: Thirteen PTBD patients from one hospital and 12 healthcare professionals from three hospitals were interviewed. The analysis of the patient interview data revealed three themes, namely, recognition of the value of transitional care services, patients have some unmet needs and perception of transitional care service pathways. Six subthemes were also identified. The analysis of the interview data of healthcare professionals revealed two themes, namely, harvest and challenges in transitional care services work and expectations for future development of transitional care services. Four subthemes were also identified. Conclusions: The transitional care of discharged patients with PTBD tubes deserves the attention of clinical workers, and a series of measures should be taken to improve transitional care services. Patient/Public Contribution: Patients were involved in the formulation of interview questions for this study, and during the interviews, patients presented their suggestions for transitional care services. Healthcare professionals participated in this study as interviewees, and no members of the public were involved in this study. [ABSTRACT FROM AUTHOR]

Introduction: Lemmel syndrome occurs when the primarily intrapancreatic portion of the common bile duct is compressed or obstructed by a duodenal diverticulum. This can cause jaundice due to the pressure. Case Presentation: A 65-year-old female patient was admitted to the emergency room with Lemmel syndrome. The patient underwent endoscopic retrograde cholangiopancreatography (ERCP), confirming the diagnosis of a diverticulum. The papilla was located in the diverticulum, and despite various attempts and maneuvers, it could not be cannulated. Subsequently, percutaneous transhepatic cholangiography (PTC) was performed, and an 8F drainage catheter was successfully placed in the duodenum. Conclusion: Lemmel syndrome is a rare condition that may cause acute abdomen with obstructive jaundice. Increased awareness and familiarity with imaging can help distinguish the diverticulum from tumors, potentially saving the patient from unnecessary surgeries. If ERCP fails, PTC may be a successful alternative for the treatment of jaundice. [ABSTRACT FROM AUTHOR]

Bile duct injury is a common and serious complication of both laparoscopic and open cholecystectomy. The conventional treatment for isolated bile duct injury is hepaticojejunostomy or hepatectomy. We present a case of biliary leak from an isolated right posterior sectoral duct after cholecystectomy treated with percutaneous sclerotherapy using alcohol. Approval and consent waiver were obtained from the Institutional Review Board (IRB 2023-CR-18).

Purpose The aim of this study was to evaluate the technical feasibility, complication rate, and efficacy of percutaneously delivered plastic biliary stent, compared with that of internal–external biliary drainage catheter.

Background: Biliary leaks are a severe complication after pediatric liver transplantation (pLT), and successful management is challenging. Objectives: The aim of this case series was to assess the outcome of percutaneous transhepatic biliary drainage (PTBD) in children with bile leaks following pLT. The necessity of additional percutaneous bilioma drainage and laboratory changes during therapy and follow-up was documented. Material and Methods: All children who underwent PTBD for biliary leak following pLT were included in this consecutive retrospective single-center study and analyzed regarding site of leak, management of additional bilioma, treatment response, and patient and transplant survival. The courses of inflammation, cholestasis parameters, and liver enzymes were retrospectively reviewed. Results: Ten children underwent PTBD treatment for biliary leak after pLT. Seven patients presented with leakage at the hepaticojejunostomy, two with leakage at the choledocho-choledochostomy and one with a bile leak because of an overlooked segmental bile duct. In terms of the mean, the PTBD treatment started 40.3 ± 31.7 days after pLT. The mean duration of PTBD treatment was 109.7 ± 103.6 days. Additional percutaneous bilioma drainage was required in eight cases. Bile leak treatment was successful in all cases, and no complications occurred. The patient and transplant survival rate was 100%. CRP serum level, leukocyte count, gamma-glutamyl transferase (GGT), and total and direct bilirubin level decreased significantly during treatment with a very strong effect size. Additionally, the gamma-glutamyl transferase level showed a statistically significant reduction during follow-up. Conclusions: PTBD is a very successful strategy for bile leak therapy after pLT.

Purpose The aim of this study was to evaluate the technical feasibility, complication rate, and efficacy of percutaneously delivered plastic biliary stent, compared with that of internal–external biliary drainage catheter. Methods Patients with unresectable malignant biliary obstruction were included who underwent percutaneous transhepatic biliary drainage and double pigtail plastic stenting (DPT-PS) or internal–external biliary drainage catheter in 15 months' duration. Results Seventy-seven patients were included in the study who underwent DPT-PS (n = 37) or internal external drainage catheter placement (n = 40). Overall, the technical success rate for percutaneous plastic stenting was 92.5% and technical success rate for primary stenting at the time of initial puncture was 62%. The incidence of fever and hemobilia was similar across the two groups, whereas bile leakage in the perihepatic space and through the skin at puncture site was higher in patients with internal–external drainage catheter. Both the techniques were effective in reducing the bilirubin levels of patients. Re-intervention was done in five patients in DPT-PS and six patients with ring biliary catheter. Conclusion DPT-PS may be used as a viable cost-efficient alternative for unresectable biliary malignancies with low post-procedure life expectancy. [ABSTRACT FROM AUTHOR]

Background: Biliary leaks are a severe complication after pediatric liver transplantation (pLT), and successful management is challenging. Objectives: The aim of this case series was to assess the outcome of percutaneous transhepatic biliary drainage (PTBD) in children with bile leaks following pLT. The necessity of additional percutaneous bilioma drainage and laboratory changes during therapy and follow-up was documented. Material and Methods: All children who underwent PTBD for biliary leak following pLT were included in this consecutive retrospective single-center study and analyzed regarding site of leak, management of additional bilioma, treatment response, and patient and transplant survival. The courses of inflammation, cholestasis parameters, and liver enzymes were retrospectively reviewed. Results: Ten children underwent PTBD treatment for biliary leak after pLT. Seven patients presented with leakage at the hepaticojejunostomy, two with leakage at the choledocho-choledochostomy and one with a bile leak because of an overlooked segmental bile duct. In terms of the mean, the PTBD treatment started 40.3 ± 31.7 days after pLT. The mean duration of PTBD treatment was 109.7 ± 103.6 days. Additional percutaneous bilioma drainage was required in eight cases. Bile leak treatment was successful in all cases, and no complications occurred. The patient and transplant survival rate was 100%. CRP serum level, leukocyte count, gamma-glutamyl transferase (GGT), and total and direct bilirubin level decreased significantly during treatment with a very strong effect size. Additionally, the gamma-glutamyl transferase level showed a statistically significant reduction during follow-up. Conclusions: PTBD is a very successful strategy for bile leak therapy after pLT. [ABSTRACT FROM AUTHOR]

Abstract Background Patients with percutaneous transhepatic biliary drainage (PTBD) need regular drainage tube care after discharge, and transitional care can help solve this problem. However, few studies have focused on the quality of transitional care, the perceptions of patients with drainage tubes after discharge and those of healthcare professionals. Aim This study is aimed at exploring the real experience and perceptions of transitional care services among healthcare professionals and PTBD patients who have been discharged with tubes and at providing references for future transitional care service development. Design The study uses a qualitative descriptive design. The reporting method followed Consolidated Criteria for Reporting Qualitative Research guidelines. Methods Semistructured interviews were conducted with PTBD patients who had been discharged with tubes and multicentre healthcare professionals using the purpose sampling method. The thematic analysis method was used for analysis. Results Thirteen PTBD patients from one hospital and 12 healthcare professionals from three hospitals were interviewed. The analysis of the patient interview data revealed three themes, namely, recognition of the value of transitional care services, patients have some unmet needs and perception of transitional care service pathways. Six subthemes were also identified. The analysis of the interview data of healthcare professionals revealed two themes, namely, harvest and challenges in transitional care services work and expectations for future development of transitional care services. Four subthemes were also identified. Conclusions The transitional care of discharged patients with PTBD tubes deserves the attention of clinical workers, and a series of measures should be taken to improve transitional care services. Patient/Public Contribution Patients were involved in the formulation of interview questions for this study, and during the interviews, patients presented their suggestions for transitional care services. Healthcare professionals participated in this study as interviewees, and no members of the public were involved in this study.

Purpose: Malignant biliary obstruction (MBO) is common in patients with advanced malignant tumors, leading to poor prognosis and hindering antitumor therapy. The purpose of our study was to assess the survival outcomes for patients under therapy after percutaneous transhepatic biliary drainage (PTBD) and identify prognostic factors associated with survival in patients with MBO. Methods: From July 2010 to February 2021, 269 patients with MBO secondary to malignant tumor were divided into two groups (functional success and non-functional success). Survival time and prognostic factors were analyzed by Kaplan–Meier curves and the Cox model. Results: The overall median survival time after PTBD was 4.6 months (95 % IC:3.9–5.3). The 3- and 6-month survival rates were 68.0 % and 38.7 %, respectively. The median survival improved from 3.2 months to 8.4 months when the procedure achieved functional success. Multivariate analysis demonstrated that functionally successful drainage and antitumor treatment after PTBD were independent positive prognostic factors, but the total bilirubin after drainage and tumor size were independent negative predictive values. Conclusions: Functionally successful drainage could prolong survival time in patients with malignant biliary obstruction. Palliative care after drainage can prolong patient survival and improve their quality of life.

Biliary fistula and bile leak are known complications following hepatobiliary surgery, trauma, and percutaneous biliary interventions. In the case of an isolated biliary system with a prolonged indwelling percutaneous transhepatic biliary drainage (PTBD) catheter, a biliary-cutaneous fistula (BCF) may develop after catheter blockage or its accidental slippage. Due to the absence of internal drainage, secreted bile flows through the matured PTBD tract to form a fistula. If left untreated, chronic BCF will result in malabsorption, infection, and delayed wound healing. Here, we report a case of left-sided BCF following prolonged PTBD for Bismuth type II cholangiocarcinoma (metastatic disease), which was initially managed by bile duct ablation using N-butyl cyanoacrylate. The patient further needed fistulous tract embolization to obliterate the BCF.

Bile duct injury is a common and serious complication of both laparoscopic and open cholecystectomy. The conventional treatment for isolated bile duct injury is hepaticojejunostomy or hepatectomy. We present a case of biliary leak from an isolated right posterior sectoral duct after cholecystectomy treated with percutaneous sclerotherapy using alcohol. Approval and consent waiver were obtained from the Institutional Review Board (IRB 2023-CR-18). [ABSTRACT FROM AUTHOR]

The recurrence rate of choledocholithiasis in the general population has been reported to exceed 10%. The incidence of cholelithiasis was reported to be higher in patients following gastrectomy than that in the general population. However, there is no study for recurrent choledocholithiasis incidence in patients following gastrectomy. This study aimed to evaluate the recurrence rate of choledocholithiasis and identify risk factors for recurrent choledocholithiasis in patients following gastrectomy. A retrospective analysis was performed on patients with gastrectomy history who underwent choledocholithiasis removal in Kyungpook National University Hospital between January 2011 and December 2019. Choledocholithiases were treated by endoscopic retrograde cholangiopancreatography (ERCP) (n = 41) or percutaneous transhepatic biliary drainage (PTBD) (n = 90). The gastrectomy type was classified as subtotal gastrectomy with Billroth I (18.3%), Billroth II (45.0%), and total gastrectomy with Roux-en-Y (36.6%). During a median follow-up period of 31.5 (range, 6–105) months, choledocholithiasis recurrence was noted in 19 of 131 patients (14.5%). In subgroup analysis, the ERCP group (24.4%) had higher choledocholithiasis recurrence than the PTBD group (10.0%). Stone removal modality (ERCP), no use of balloon sphincteroplasty, and the presence of periampullary diverticulum were significant risk factors for recurrent choledocholithiasis. In multivariate analysis, ERCP (hazard ratio (HR), 3.597; 95% confidence interval (CI): 1.264–10.204) CBD stricture (HR, 3.823; 95% CI: 1.118–13.080) and no use of balloon sphincteroplasty (HR, 4.830; 95% CI: 1.669–13.889) were risk factors for recurrent choledocholithiasis following stone removal. The incidence of CBD stones in patients who underwent gastrectomy is similar to that of the general population. ERCP, CBD stricture, and no use of balloon sphincteroplasty are potential risk factors for recurrent CBD stones following gastrectomy. When we consider PTBD disadvantages, the ERCP procedure with active use of balloon sphincteroplasty is recommended to decrease recurrent CBD stones. [ABSTRACT FROM AUTHOR]

Biliary fistula and bile leak are known complications following hepatobiliary surgery, trauma, and percutaneous biliary interventions. In the case of an isolated biliary system with a prolonged indwelling percutaneous transhepatic biliary drainage (PTBD) catheter, a biliary-cutaneous fistula (BCF) may develop after catheter blockage or its accidental slippage. Due to the absence of internal drainage, secreted bile flows through the matured PTBD tract to form a fistula. If left untreated, chronic BCF will result in malabsorption, infection, and delayed wound healing. Here, we report a case of left-sided BCF following prolonged PTBD for Bismuth type II cholangiocarcinoma (metastatic disease), which was initially managed by bile duct ablation using N-butyl cyanoacrylate. The patient further needed fistulous tract embolization to obliterate the BCF. [ABSTRACT FROM AUTHOR]

Introduction. Malignant biliary obstruction represents a poor prognostic sign of metastatic colorectal carcinoma. Percutaneous transhepatic biliary drainage (PTBD) is the procedure of choice for palliative biliary decompression, and this method has both diagnostic and therapeutic values. One of the wellknown complications following this procedure is the development of catheter tract metastases that occur in 0.6–6% of cases post-PTBD. In this case report, we present a patient with implantation metastases of colorectal cancer following PTBD. Case report. In the last six years, 89 patients underwent PTBD procedure at the Oncology Institute of Vojvodina. Among these patients, catheter tract implantation metastasis developed in one patient (1.1%). In this report, we present a patient who underwent right hemicolectomy in January 2015 at the Oncology Institute due to colon cancer located in the transverse colon. In January of 2018, a computed tomography scan of the abdomen showed metastatic disease and chemotherapy was initiated. However, 29 months following the start of chemotherapy, the patient developed jaundice, and as a result, PTBD procedure was performed. A control computed tomography scan of the abdomen in March of 2021 showed a de novo subcutaneous nodule 20 mm in diameter located at the level of ninth right rib. The nodule had been considered a part of the scar that formed at a place of catheter entry, and was still present eight months after PTBD procedure. Biopsy of the subcutaneous mass and pathohistological analysis confirmed well differentiated colon adenocarcinoma. Conclusion. Catheter tract implantation metastasis is not a rare complication following PTBD for malignant biliary obstruction. It generally has a poor prognosis. Nevertheless, literature review shows that radical surgical excision of the catheter tract tissue with hepatectomy can prolong survival in select group of patients.

Background: Malignant obstructive jaundice is associated with a poor prognosis. Patients can undergo percutaneous transhepatic biliary drainage (PTBD), but the impact it has on quality of life is not well understood. Objective: To assess the potential impact of PTBD on quality of life in patients with obstructive jaundice from advanced malignancy using surrogate markers including complications, hospital length of stay, readmission, reintervention, and mortality. Methods: A retrospective analysis of a single-centre cohort of all patients with advanced solid organ malignancy undergoing PTBD between April 2020 and February 2022. Data was collected from electronic medical records. Results: Among the sixteen patients, abdominal pain and cholangitis were observed in 62.5% and 37.5% patients, respectively. Peritonitis, biliary leak, perihepatic abscess, and haemobilia occurred in individual cases. The median hospital length of stay post PTBD was nine days. The 30-day readmission rate for PTBD-related complications was 31.3% with a median of three total readmissions per patient. The 30-day reintervention rate was 62.5%. The 30-day all-cause mortality was 25% (95% CI:8.9-53.3), which included one procedure-related death. Conclusions: Quality of life in patients with obstructive jaundice from advanced solid organ malignancy undergoing PTBD can be adversely impacted due to the high risk of complications, reintervention, hospitalisation, and mortality. Thorough patient assessments are crucial in selecting appropriate candidates for PTBD. [ABSTRACT FROM AUTHOR]

Aim: Severe complications such as bacteremia and bile duct infection may arise following percutaneous transhepatic biliary drainage (PTBD). The objective of this study was to examine the factors that contribute to mortality and compare the differences between patients with positive blood and biliary drainage cultures following PTBD. Materials and Methods: This retrospective study was conducted from January 2017 to February 2019. The study was carried out at a hospital where 547 percutaneous transhepatic biliary drainage (PTBD) procedures were performed during this period. The study evaluated patients who showed no signs of infection prior to the procedure. The patients were categorized into three groups based on culture results: the first group with only bacteremia' the second group with only positive bile drainage culture' and the third group with both bacteremia and positive bile drainage culture. This study compared the clinical and laboratory parameters among these groups and examined the culture results in a high-resistance environment. Results: Ninety patients either developed bacteremia, bile duct infections, or both in this study. The laboratory results revealed that patients with bacteremia exhibited a notably higher serum level of alanine aminotransferase. (ALT) (p=0.001). Independent risk factors associated with 30-day mortality after PTBD included elevated neutrophil counts, lipase levels, and the presence of carbapenem-resistant isolates (p=0.01, p=0.01, and p=0.04, respectively). Gram-negative organisms were present in 71.2% of the cases; Escherichia coli was the most common species (28.1%) followed by Enterococcus faecium (18.1%), Klebsiella pneumoniae (15.8%) and Pseudomonas aeruginosa (9.9%). Of the cultured gram-negative bacteria, 41.8% (51 isolates) were found to be positive for extended spectrum beta-lactamases, while 15.8% (27 isolates) of the isolates showed carbapenem resistance. [ABSTRACT FROM AUTHOR]

Predicting response to biliary drainage is critical to stratify patients with acute cholangitis. Total leucocyte count (TLC) is one of the criteria for predicting the severity of cholangitis and is routinely performed. We aim to investigate the performance of neutrophil-lymphocyte ratio (NLR) in predicting clinical response to percutaneous transhepatic biliary drainage (PTBD) in acute cholangitis. This retrospective study comprised consecutive patients with acute cholangitis who underwent PTBD and had serial (baseline, day 1, and day 3) TLC and NLR measurements. Technical success, complications of PTBD, and clinical response to PTBD (based on multiple outcomes) were recorded. Univariate and multivariate analysis was performed to identify factors significantly associated with clinical response to PTBD. The sensitivity, specificity, and area under the curve of serial TLC and NLR for predicting clinical response to PTBD were calculated. Forty-five patients (mean age 51.5 years, range 22–84) met the inclusion criteria. PTBD was technically successful in all the patients. Eleven (24.4%) minor complications were recorded. Clinical response to PTBD was recorded in 22 (48.9%) patients. At univariate analysis, the clinical response to PTBD was significantly associated with baseline TLC (P = 0.035), baseline NLR (P = 0.028), and NLR at day 1 (P=0.011). There was no association with age, the presence of comorbidities, prior endoscopic retrograde cholangiopancreatography, admission to PTBD interval, diagnosis (benign vs. malignant), severity of cholangitis, organ failure at baseline, and blood culture positivity. At multivariate analysis, NLR-1 independently predicted the clinical response. Area under the curve of NLR at day 1 for predicting clinical response was 0.901. NLR-1 cut-off value of 3.95 was associated with sensitivity and specificity of 87% and 78%, respectively. TLC and NLR are simple tests that can predict clinical response to PTBD in acute cholangitis. NLR-1 cut-off value of 3.95 can be used in clinical practice to predict response. [ABSTRACT FROM AUTHOR]

Background: Complication rates in percutaneous transhepatic biliary drainage (PTBD) are non-uniform and vary considerably. In addition, the impact of peri-procedural risk factors is under-investigated. Purpose: To compare success and complication rates of PTBD in patients with and without accompanying technical risk factors. Material and Methods: A single-center retrospective study was conducted from January 2004 to December 2016. Patients receiving PTBD due to biliary obstruction or biliary leakage were included. Technical risk factors (non-distended bile ducts, ascites, obesity, anasarca, non-compliance) were assessed. Complications were classified according to the Society of Interventional Radiology. Results: In total, 372 patients were included (57.3% men, 42.7% women; mean age = 66 years). Overall, 466 PTBDs were performed. Of the patients, 70.1% presented with malignancy and biliary obstruction; 26.8% had benign biliary obstruction; 3.1% had biliary leakage. Technical risk factors were reported in 57 (15.3%) patients. Overall technical success of initial PTBD was 98.7%, primary technical success was 97.9%. In patients with non-dilatated bile ducts, primary technical success was 68.2%. Overall complication rate was 15.0% (8.1% major complications, 6.9% minor complications). Neither major nor minor complications were more frequent in patients with technical risk factors (P > 0.05). In left-sided PTBD, hemorrhage was more frequent (P = 0.015). Patients with malignancy were significantly more affected by drainage-related complications (P = 0.004; odds ratio = 2.03). The mortality rate was 0.5% (n = 2). Conclusion: PTBD is a safe and effective method for the treatment of biliary obstruction and biliary leaks. Complication rates are low, even in procedures with risk factors. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the response and outcome with prolonged intravenous antibiotics including home-based intravenous antibiotics in children with intractable cholangitis (IC) after Kasai portoenterostomy (KPE) for biliary atresia (BA). Methods: A retrospective review of treatment and outcome of children with IC post KPE (no resolution after four weeks of antibiotics) was done between 2014 and 2020. A protocol-based antibiotic regimen was used based on sensitivity and hospital antibiogram. Children afebrile for more than three days were discharged on home intravenous antibiotics (HIVA). Results: Twenty children with IC were managed with prolonged antibiotic regimen, including HIVA. All patients were initially listed for liver transplantation (LT) with indication being IC (n = 20) with portal hypertension (n = 12). Seven patients had bile lakes of which four underwent percutaneous transhepatic biliary drainage. Bile culture grew Klebsiella in four and Escherichia coli and Pseudomonas one each. There were eight children with IC who had positive blood culture with most of these organisms being gram-negative (Escherichia coli: 5, Klebsiella pneumoniae: 2, Enterococcus: 1). Median duration of antibiotics was 58 days (interquartile range [IQR] 56–84). Median follow-up period post cholangitis was three years (IQR 2–4). Following treatment, 14 patients were successfully delisted from LT waitlist and are presently jaundice-free. Two of the five patients undergoing LT died of sepsis. One patient died awaiting LT. Conclusion: Timely and aggressive step-up antibiotic regimen may successfully treat IC and prevent/delay LT. HIVA provides a cost-effective and comfortable environment for a child which might improve compliance with intravenous antibiotics. [ABSTRACT FROM AUTHOR]

Percutaneous transhepatic biliary drainage (PTBD) is an effective procedure for correcting biliary obstructions. It can be performed under ultrasound and fluoroscopic equipment; however, it may entail serious complications, including bleeding, caused by arterial or venous injury. We present a 49-year-old man presented with a 1-month history of icterus, jaundice, dark urine, and right hypochondrial pain. MR imaging discovered a dilatation of the right intrahepatic bile duct due to obstruction by intrahepatic cholangiocarcinoma. PTBD procedure was performed in the right intrahepatic bile duct. After the pigtail drain device was inserted, the bile fluid color that came out from the pigtail turned sanguineous; nonetheless, the patient's hemodynamic was stable. Therefore, the second cholangiography was performed for evaluation. Some resistance was sensed during contrast injection into the bile duct, and the operator pushed the contrast media a little bit stronger and found a filling defect formed by a clot in the bile duct that suggested high suspicion of vessel injury. Although the patient's hemodynamics was still stable, the operator quickly decided to perform a hepatic arteriography procedure because bright red blood through the tube and a relatively rapid clot formed from the puncture point and distal drain, which were signs of hepatic artery injury. Hepatic arteriography confirmed the location of pseudoaneurysm caused by vessel trauma and arterio-intrahepatic bile duct fistulation. The embolization procedure was performed using PVA-300 into a ruptured hepatic artery branch through a microcatheter. Re-evaluation arteriography showed no pseudoaneurysm or arterio-intrahepatic bile duct fistulation after embolization.

Percutaneous transhepatic biliary drainage (PTBD) is an effective treatment for benign and malignant obstructive jaundice. Major bleeding complications occur in approximately 2–3% of patients after PTBD, which can result in death. A case involving a 63-year-old male with malignant obstructive jaundice, who experienced severe bleeding after PTBD, is reported. Emergency digital subtraction angiography, celiac trunk artery and superior mesenteric artery angiography were performed; however, no signs of arterial bleeding were found. To identify etiology, portal venography was performed under ultrasound guidance and portal vein bleeding was diagnosed. Ultimately, selective portal vein embolization successfully stopped the bleeding.

Aim. To evaluate the safety and accuracy of percutaneous transhepatic biliary biopsy in patients with suspected Klatskin tumor.Materials and methods. Between 2013–2020, percutaneous transhepatic biliary drainage (PTBD) was performed in 52 patients with Klatskin tumor, complicated by obstructive jaundice. After successful PTBD, the diagnosis was verified by antegrade access. 74 procedures were performed: brush (n = 36; 48.6 %) or forceps biopsies (n = 38; 51.4 %).Results. There were no adverse events associated with a brush biopsy. Only grade I complications were after the forceps technique: 3 patients (7.9 %) developed hemobilia, which was corrected conservatively. Malignant lesions of the biliary tract were detected by forceps technique in 79.0 %, brush biopsy in 66.7 % (p >0,05). The degree of tumor differentiation was determined in 60.0 % (n = 18) vs 12.5 % (n = 3) (p < 0,01), respectively.Sensitivity and specificity of forceps biopsy were slightly higher than in brush: 82.4 % and 75.0 % vs 73.3 % and 66.7 % (p >0,05).Conclusions. Antegrade percutaneous transhepatic biliary biopsy is safe for both brush and forceps techniques. However, forceps biopsy has higher sensitivity and specificity in the diagnosis Klatskin tumor and better possibility of determining the degree of malignancy differentiation.

Background: Patients with moderate–severe cholangitis require urgent/early biliary drainage and failed endoscopic retrograde cholangiopancreatography (ERCP) warrants use of percutaneous drainage. While endoscopic ultrasound-guided biliary drainage (EUS-BD) has evolved as an effective salvage modality but its safety and efficacy data in moderate–severe cholangitis are limited. Patients and methods: All consecutive moderate–severe cholangitis patients, with failed/technically non-feasible ERCP requiring EUS-BD in two tertiary care centers were included. Baseline laboratory and demographic parameters were documented. Technical and clinical success were primary outcome measures. Additionally, effective biliary drainage, adverse events due to procedure, hospital stay, ICU stay, and mortality were noted. Results: Of the 49 patients (23 male; 46.9%) presenting with moderate/severe cholangitis, 23 (46.9%) had severe cholangitis. The median Charleston comorbidity index was 7.0 (IQR 2.0). Majority had malignant disease (87.8%) and 25 (51.0%) had inaccessible papilla. Technical success was achieved in 48 cases (98.0%), while clinical success with improvement of cholangitis was noted in 44 of 48 cases (91.7%). Effective biliary drainage was noted in 85.4% (41/48) cases. Adverse events in the form of mostly bleeding and bile leak were noted in 5 cases (10.2%) but managed conservatively. Distal obstruction exhibited significantly better clinical success (100% vs. 78.9%; p = 0.02) than hilar obstruction. Severe cholangitis had significantly lower clinical success (81.8% vs. 100%; p = 0.04) than moderate cholangitis. Conclusion: EUS-BD can be a safe and effective alternative option for patients with moderate to severe cholangitis, even with significant pre-morbid conditions, with acceptable adverse events rate. [ABSTRACT FROM AUTHOR]

Abstract This study aimed to describe our experience and discuss the results, controversies, and the use of percutaneous transhepatic biliary drainage (PTBD) in patients with biliary complications after liver transplantation (LT). Between November 2009 and August 2020, 76 consecutive patients who underwent 77 LTs (44 deceased donor LTs and 33 living donor LTs [LDLT]) were enrolled retrospectively. Endoscopic therapy as initial approach and PTBD as rescue therapy were used for patients with biliary complications. There were 31 patients (31/76, 40.8%) with biliary complications, and two of them died (2/31, 6.5%). Clinical success rate of endoscopic therapy alone was 71.0% (22/31). The remaining nine patients received salvage PTBD and their clinical results were observed according to whether their intrahepatic bile ducts (IHBDs) was dilated (group A, n = 5) or not (group B, n = 4). In group A, the technical and long‐term clinical success rates of PTBD were 100% and 20%, respectively. These five patients received PTBD ranging from 75 to 732 days after their LTs, and no procedure‐related complications were encountered. In group B, the technical and long‐term clinical success rates of PTBD were 50% and 25%, respectively. Three group B patients (75%) underwent PTBD within 30 days after LDLT and had lethal complications. One patient had graft laceration and survived after receiving timely re‐transplantation. The other two patients died of sepsis due to PTBD‐related bilioportal fistula or multiple liver abscesses. Our experience showed salvage PTBD played a limited role in biliary complications without dilated IHBDs within 1 month after LT.

A 56-year-old male underwent a Whipple procedure for duodenal stricture secondary to a 32-mm duodenal adenocarcinoma. The patient presented again 66 months later with obstructive jaundice caused by an obstruction in the afferent loop. Biliary drainage was performed to relieve the obstruction. Two attempts to cross the occlusion were performed, but these were both unsuccessful. Percutaneous transhepatic stent deployment through the obstruction has previously been described in similar cases but was not feasible in this case. An attempt at retrograde cannulation was performed from a direct puncture of the bowel but this failed. Rather than abandoning the case, an extra-anatomic approach was taken by passing a needle across the point of malignant obstruction forming a new track between the Roux loop and small bowel, enabling a covered stent to be placed and relieving the biliary obstruction. This avoided the need for permanent external biliary drainage and its associated complications. Extra-anatomic percutaneous stenting is a viable alternative for the treatment of malignant afferent loop obstruction following pancreaticoduodenectomy.

Introduction: Metastatic gallbladder cancer (GBC) is a highly fatal malignancy and it is difficult to treat the advanced stage of GBC. In India, northern and northeastern states are the worst affected by this disease. We, hereby, report the clinicoepidemiological and management profile of 242 patients of metastatic carcinoma of GB. Materials and Methods: In this study, a total of 242 cases of metastatic GBC (detected either on the first presentation or during follow-up) were managed at the Department of Medical Oncology tertiary care oncology center in the northeast part of India from May 2018 to September 2019. On presentation, all patients were subjected to detailed history and clinical examination, followed by requisite investigations and were treated as per the existent guidelines. Results: One-hundred and forty-two patients were female, while 100 patients were male out of 242 patients. Female patients with metastatic GBC presented with the mean age of 54, while for males, 51.4 years. The most common presentation was pain abdomen (81.8%), while the second most common was anorexia (77.2%), followed by weight loss (62.8%) and mass per abdomen (60.7%). The most common site of metastasis recorded in our study was the liver (79.7%), followed by nonregional abdominal lymph node (69.4%) and ascites (64.4%). Out of the 242 patients, 24 patients had presented in poor Eastern Cooperative Oncology Group Performance Status (≥3) hence were deemed unfit for any oncological interventions. About 136 (56.1%) patients had presented with features of obstructive jaundice, however only 108 patients were subjected to biliary drainage procedure. After the biliary drainage procedures, only one-third (38 out of 136; 35.1%) of patients were finally able to receive chemotherapy. Conclusion: In India, unfortunately, many patients present very late during the course of their illness. There is a need for the development of effective chemotherapy or targeted therapy and also there is an unmet need for patients' education. There has been an increase in the incidence of this malignancy, especially in the Northeast part of India; hence, it is the need of the hour to study various epidemiological and causative factors of the disease. Furthermore, the development of therapies for the effective management of this malignancy is really required. [ABSTRACT FROM AUTHOR]

Introduction/Objective. Colorectal cancer (CRC) is currently the third most common cancer in incidence in the United States and accounts for about 8.5% of all cancer related deaths. Our study aim was to determine the parameters that contribute to the survival of CRC patients with hepatic dysfunction, attention to the positive effects on survival when the most appropriate clinical approaches. Methods.Patients with CRC, diagnosed with hepatic dysfunction, and who were followed up in our inpatient service in the last two years were included in our study. Survival rates were analyzed starting from after the development of hepatic failure. Results. A total of 57 patients were included in the study, 44 (77.2%) were colon carcinoma, and 13 (22.8%) were rectal carcinoma patients, and 14 (24.56%) were female. Bile duct dilatation (BD) was detected in 19 (33%) of 57 patients with imaging methods. The median OS was calculated as 4 vs. 1.4 months in patients with BD compared to patients without BD (p < 0.001). Survival times were significantly higher in patients with BD compared to those without dilatation, and in patients without renal failure compared to those with renal failure. Conclusion. In cancer patients with hepatic dysfunction, those with additional renal failure had shorter survival times and a worse prognosis. The longer survival of patients with BD was attributed to the optimal timing of the percutaneous transhepatic cholangiography insertion, close clinical and inflammation marker follow-ups, and early prevention of external biliary drainage, therefore preventing a possible septic complication early on.

The recurrence rate of choledocholithiasis in the general population has been reported to exceed 10%. The incidence of cholelithiasis was reported to be higher in patients following gastrectomy than that in the general population. However, there is no study for recurrent choledocholithiasis incidence in patients following gastrectomy. This study aimed to evaluate the recurrence rate of choledocholithiasis and identify risk factors for recurrent choledocholithiasis in patients following gastrectomy. A retrospective analysis was performed on patients with gastrectomy history who underwent choledocholithiasis removal in Kyungpook National University Hospital between January 2011 and December 2019. Choledocholithiases were treated by endoscopic retrograde cholangiopancreatography (ERCP) (n = 41) or percutaneous transhepatic biliary drainage (PTBD) (n = 90). The gastrectomy type was classified as subtotal gastrectomy with Billroth I (18.3%), Billroth II (45.0%), and total gastrectomy with Roux-en-Y (36.6%). During a median follow-up period of 31.5 (range, 6–105) months, choledocholithiasis recurrence was noted in 19 of 131 patients (14.5%). In subgroup analysis, the ERCP group (24.4%) had higher choledocholithiasis recurrence than the PTBD group (10.0%). Stone removal modality (ERCP), no use of balloon sphincteroplasty, and the presence of periampullary diverticulum were significant risk factors for recurrent choledocholithiasis. In multivariate analysis, ERCP (hazard ratio (HR), 3.597; 95% confidence interval (CI): 1.264–10.204) CBD stricture (HR, 3.823; 95% CI: 1.118–13.080) and no use of balloon sphincteroplasty (HR, 4.830; 95% CI: 1.669–13.889) were risk factors for recurrent choledocholithiasis following stone removal. The incidence of CBD stones in patients who underwent gastrectomy is similar to that of the general population. ERCP, CBD stricture, and no use of balloon sphincteroplasty are potential risk factors for recurrent CBD stones following gastrectomy. When we consider PTBD disadvantages, the ERCP procedure with active use of balloon sphincteroplasty is recommended to decrease recurrent CBD stones.

Management of complicated cholelithiasis (gallstone disease) in elderly patients is often limited to the use of only minimally invasive interventions.Case report. We report three clinical cases of gallstone disease complications in patients over 75 years old who had previously undergone minimally invasive surgery and who was refused radical surgical treatment due to comorbidity. In two patients, this led to the development of purulent cholangitis and multiple organ failure, which required emergency hospitalization. At the first stage, biliary drainage was performed; then the multidisciplinary team managed to stabilize the condition of the patient; at the second stage, biliodigestive anastomoses were formed through laparotomic access on a loop turned off by the Ru. Complete relief of symptoms was achieved and no relapse was observed.In another case, cholecystoduodenal fistula with stone migration and complete obstruction of the small intestine was found during laparotomy in an asymptomatic patient hospitalized for elective surgery.Discussion. Comorbidity should not be considered as an absolute contraindication to radical surgery of complicated cholelithiasis in elderly patients: gallstone disease complications in most cases exceed the risks of surgical intervention. Radical surgery of complicated gallstone disease in patients over 75 years old is possible in condition of patient management by a multidisciplinary team.

Background: Percutaneous Transhepatic Biliary Drainage (PTBD) is a minimally invasive procedure to palliate the biliary obstruction caused by unresectable malignancy. Aims and Objective: To analyze the outcome of PTBD in patients of unresectable gall bladder cancer presenting with obstructive jaundice in terms of reduction in serum bilirubin levels, symptomatic improvement, and overall survival (OS) at 4 weeks and 12 weeks following the procedure. Materials and Methods: In this retrospective study, PTBD was attempted on 30 patients diagnosed with inoperable gall bladder cancer. Various patient and procedure-related variables were analyzed and recorded both pre and post-PTBD. Outcome data on OS was collected at 4 weeks and 12 weeks. Results: Technical success was achieved in 29 (99.66%) patients. The mean fall in the serum bilirubin at the 7th post-procedural day was 41.5% after the successful PTBD. The most common complication in our study was cholangitis noted in six (21%) patients. OS at 4 weeks and 12 weeks was 79% and 41%, respectively. Conclusion: Younger age and good performance status favored better survival rate in our study.

Preoperative biliary drainage (PBD) was primarily introduced to reduce perioperative complications following hepato-pancreato-biliary surgeries. There is no proper consensus on the routine use of PBD before pancreaticoduodenectomy (PD). This is a prospective observational study of patients who underwent PD between July 2013 and December 2014. The study group was divided into two groups based on whether a preoperative biliary drainage was performed or not. The intraoperative and postoperative complications were compared among the two groups. A total of 59 patients, predominantly males (64.4%) with a median age of 58 years, were included in study. All except 5 (8.5%) had undergone PD for periampullary malignancy. Thirty-eight patients (64.4%) underwent an upfront PD and the remaining 21 (35.5%) had undergone PBD. Cholangitis was the indication for PBD in all patients. The mean operative time (307.89 ± 52.51 min vs. 314.29 ± 36.273; p value = 0.62) and postoperative complications like delayed gastric emptying (63.2% vs. 61.9%; p value-0.924), postoperative pancreatic fistula (21.1% vs. 33.3%; p value 0.3), post-pancreaticoduodenectomy haemorrhage (5.3% vs. 9.5%; p value-0.611) and mean in-hospital stay were comparable among two groups. Even though the incidence of positive intraoperative bile cultures is significantly higher among the stented group (95.2% vs. 26.3%; p value = 0.0), no significant difference in surgical site infections (47.6% vs. 28.9%; p value 0.152) was noted. The overall mortality was 1.7% (1/59; grade C PPH). This study showed no significant difference in the postoperative complications following PBD despite increase in bile culture positivity. However, notable differences in the spectrum of microbial growths between stented and non-stented groups were observed. [ABSTRACT FROM AUTHOR]

Background/aim: To evaluate the safety and outcomes of percutaneous transhepatic management of dysfunctioning plastic biliary endoprostheses (PBE) in patients with benign/malign biliary strictures. Materials and methods: Twenty-nine patients (22 men, 7 women; mean age of 60.7 (range 33-88) years) diagnosed with dysfunctioning PBE were included. Percutaneous transhepatic biliary drainage and subsequent PBE dislodgment into the bowel were performed in all cases. Patient demographics, etiology of the biliary stricture, indication, technical success, complications, and clinical outcomes were gleaned from medical records. Results: Seventeen patients had malignant strictures, while 12 patients had benign conditions. A total of 36 PBE (33 straight, 3 double-J) were treated. Six patients had more than one PBE. Successful dislodgement of the PBE was achieved in 28 (96.6%) of the cases. Monorail threading was performed in 8 cases while dislodgement by balloon friction was utilized in 21 patients. There was no statistical significance between benign and malignant biliary strictures regarding dislodgement duration (p = 0.080). No major complication was encountered. Thirteen minor complications in 10 patients including abdominal pain (n = 8) and mild hemobilia (n = 5) were observed and treated conservatively. Uneventful passage of the PBE was reported by all patients with technical success. Conclusion: Percutaneous transhepatic methods aid as a reasonable alternative in the treatment of benign and malignant biliary strictures in patients with dysfunctioning PBE when endoscopic approaches fail or are not eligible. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to explore the efficacy and safety of endoscopic ultrasound-guided biliary drainage (EUS-BD) and percutaneous transhepatic biliary drainage (PTCD) in patients with malignant biliary obstruction and failed endoscopic retrograde cholangiopancreatography. Methods: We searched PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov to identify studies reporting outcomes comparing EUS-BD and PTCD. Results: We identified 9 studies involving 469 patients. Technical success was similar for EUS-BD and PTCD (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.17-3.30; P = .71). EUS-BD was associated with higher clinical success versus PTCD (OR, 2.11; 95% CI, 1.15-3.87; P = .02) in all studies. However, there was no significant difference between groups in studies using self-expandable metal stents (OR, 0.36; 95% CI, 0.06-2.00; P = .24). The reported adverse event rate was significantly lower for EUS-BD compared with PTCD (OR, 0.33; 95% CI, 0.22-0.52; P < .00001). Conclusion: The available literature suggests that EUS-BD is associated with fewer adverse events, greater clinical success, and comparable technical success compared with PTCD. According to the shortcomings of our study, more large, high-quality, randomized controlled trials are needed to compare these techniques and confirm our findings. [ABSTRACT FROM AUTHOR]

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for their analgesic and anti-inflammatory effects but can lead to serious gastrointes complications. This report illustrates the management of an NSAID-induced penetrating gastric ulcer with subsequent postoperative hemorrhagic cholecystitis. A 68-year-old female with chronic NSAID use presented with epigastric pain and was diagnosed with a penetrating gastric ulcer extending into the retroperitoneum. The surgical management required a shift from a minimally invasive robotic-assisted approach to an open procedure due to unexpected intraoperative findings. The postoperative period was notable for the development of hemorrhagic cholecystitis that was managed with percutaneous transhepatic biliary drainage, highlighting the role of interventional radiology in complex postoperative care. NSAID use significantly increases gastrointestinal risks, leading to complications such as ulcers that may penetrate into adjacent structures, including the retroperitoneum. The management of penetrating gastric ulcers typically involves complex surgical procedures, highlighted in this scenario by the necessity for an antrectomy followed by a Billroth II reconstruction to address the extensive damage and restore gastrointestinal continuity, which is essential for patient recovery. In this case, the development of hemorrhagic cholecystitis postoperatively was effectively managed with a percutaneous transhepatic biliary drain, demonstrating the importance of interventional radiology in managing postoperative complications and the need for a multidisciplinary approach. This case report elucidates the management of NSAID-induced penetrating gastric ulcer that extended into the retroperitoneum, necessitating an antrectomy with Billroth II reconstruction. A gastric ulcer is generally classified as "large" if it exceeds 2 centimeters in diameter. These ulcers pose greater risks of complications such as perforation, penetration into adjacent organs, bleeding, and obstruction, necessitating more complex and comprehensive management strategies. The postoperative complication of hemorrhagic cholecystitis was effectively managed via interventional radiology, highlighting the critical role of minimally invasive techniques in addressing severe postoperative complications., (Published by Elsevier Inc. on behalf of University of Washington.)