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[Radiologic intervention in the biliary tract performed at a central hospital]
O A Bjerkeset1, L Fjetland, I Tollefsen
1Sentralsjukehuset i Rogaland, Stavanger.
Summary
Percutaneous transhepatic bile drainage (PTBD) offers an alternative for obstructive jaundice when endoscopic therapy fails. While effective, PTBD procedures carry risks, including serious complications and mortality.
Area of Science:
- Radiology
- Gastroenterology
- Interventional Radiology
Background:
- Obstructive jaundice is frequently caused by malignant disease.
- Percutaneous transhepatic cholangiography (PTC) and drainage are established interventions.
Purpose of the Study:
- To evaluate the outcomes and complications of percutaneous transhepatic bile drainage (PTBD) for obstructive jaundice.
- To compare PTBD with endoscopic bile drainage.
Main Methods:
- 131 diagnostic PTCs and 54 percutaneous transhepatic bile drainage (endoprosthesis) (PTBD) and 53 percutaneous transhepatic external drainage (PTED) procedures were performed between 1987-96.
- Procedures utilized fluoroscopic or ultrasonographic guidance.
- Standardized endoprostheses and drainage catheters were employed.
Main Results:
- Malignant disease accounted for 86% of obstructive jaundice cases.
- Complications occurred in 23% of patients, with 3 deaths (2.5%) directly related to procedures.
- 30-day mortality for endoprosthesis treatment was 20% (11/51 patients).
Conclusions:
- Percutaneous transhepatic bile drainage is a viable alternative for obstructive jaundice, particularly when endoscopic therapy is unsuccessful.
- Endoscopic bile drainage is recommended as the primary treatment of choice.
- Careful patient selection and procedural technique are crucial to minimize PTBD-related risks.