PERCUTANEOUS BILIARY DRAINAGE: A REVIEW OF 150 CASES
Keywords:Biliary intervention, Biliary malignancy, Cholangiogram, Obstructive jaundice, Percutaneous biliary drainage
Objective: To review our technique of ultrasound and fluoroscopically guided Percutaneous Transhepatic Biliary Drainage (PTBD) procedures, and compare our complication rate with internationally accepted standards.
Study Design: Retrospective study.
Place and Duration of Study: Department of Interventional Radiology, Armed Forces Institute of Radiology and Imaging, Rawalpindi, Pakistan, from Jan 2017 to Oct 18.
Material and Methods: Procedure was performed on 159 adult patients. All the referrals were evaluated with a CT scan, 148 cases were done in direct ultrasound guidance while 2 were done via fluoroscopy. USG guided puncture of bile ducts was done. Internalization was attempted. Depending on the outcome of attempt, external or internal – external locking pigtail drains were placed over wire. Patients were monitored for early and delayed complications. Data was organized in MS Excel 2007.
Results: Percutaneous biliary drainage procedures were successfully performed in 148 out of 150 patients (98.6%) of obstructive jaundice. Ultrasound guided punctures of dilated bile ducts were made using predominantly needles of 18G and 20G. The technique was varied according to the pathology of the patient and the degree/level of obstruction. Eighty drains were placed via left sided access (54%), 52 via right sided access (35%) and bilateral drainage was done in 16 cases (11%). Internalization was achieved in 90 (60.8%) cases while external drain placement was done in 58 cases (39.2%). In the second attempt made in 19 cases, 12 (63%) were internalized. Our complication rate was up to 12% for minor and up to 5% for major complications. We had a mortality of 1.3%. Our technique was cost-effective.
Conclusion: Ultrasound guided percutaneous biliary drainage in experienced hands is a useful palliative procedure. Variations in technique to suit patient pathology and other constraints is often necessary without affecting outcome. Poor general condition of these patients and the variable technical difficulties in the procedure entail certain complications and mortality within limits.