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Percutaneous transhepatic biliary drainage in patients at higher risk for adverse events: experience from a tertiary care referral center
- Source :
- Abdominal Radiology. 45:2547-2553
- Publication Year :
- 2019
- Publisher :
- Springer Science and Business Media LLC, 2019.
-
Abstract
- Despite advances in endoscopic drainage procedures, percutaneous transhepatic biliary drainage (PTBD) remains an essential interventional radiology (IR) procedure. Several factors may adversely affect the success of PTBD. We report the experience of our IR unit with PTBD in patients considered at higher risk for adverse events. Consecutive PTBDs performed between November 2017 and April 2019 were retrospectively reviewed. The patients at increased risk for adverse events from PTBD, defined by one or more of the following factors: non-dilated system, moderate amount of perihepatic fluid, coagulopathy, altered sensorium, and PTBD performed at bedside, were identified. Technical success, complications, and outcome at 3 months were recorded. During the study period, PTBDs were performed in 90 patients. PTBDs in 57 (63.3%) patients (mean age 47.6 years, 35 females) were identified as predisposing to higher risk for adverse events. Left and right PTBD were performed in 37 (64.9%) and 15 (26.3%) patients, respectively. Bilateral PTBDs were performed in three (5.2%) patients. In two (3.5%) cases, biliary access was obtained via percutaneous cholecystostomy. Overall technical success of 91.2% (n = 52) was achieved. Carcinoma gallbladder was the most common underlying cause. Non-dilated ductal system was the most common condition deemed to predispose to higher risk for adverse events (n = 32, 56.1%), followed by perihepatic fluid (n = 9, 15.8%), and deranged coagulation parameters (n = 9, 15.8%). PTBD was performed at bedside in intensive care unit in 5 (8.8%) patients. Two (3.5%) patients had altered sensorium. Major complications in the form of biliary peritonitis were observed in three (5.2%) patients. No procedure-related mortality was observed. PTBD can be effectively and safely performed even in situations deemed to predispose patients to increased risk for adverse events. Thus, the mere presence of these conditions should not cause a denial of PTBD.
- Subjects :
- medicine.medical_specialty
Urology
Tertiary care
030218 nuclear medicine & medical imaging
law.invention
Tertiary Care Centers
03 medical and health sciences
0302 clinical medicine
law
Internal medicine
Coagulopathy
Humans
Medicine
Radiology, Nuclear Medicine and imaging
In patient
Adverse effect
Retrospective Studies
Radiological and Ultrasound Technology
medicine.diagnostic_test
Tertiary Healthcare
business.industry
Gastroenterology
Interventional radiology
Middle Aged
Hepatology
medicine.disease
Intensive care unit
Surgery
Treatment Outcome
030220 oncology & carcinogenesis
Drainage
Female
Percutaneous transhepatic biliary drainage
business
Subjects
Details
- ISSN :
- 23660058 and 2366004X
- Volume :
- 45
- Database :
- OpenAIRE
- Journal :
- Abdominal Radiology
- Accession number :
- edsair.doi.dedup.....6f70734e57b730f2807d96d811872296