Related Experiment Videos
[Cholangitis and percutaneous biliary drainage]
R A Audisio1, G Cozzi, F Bozzetti
1Divisione di Oncologia Chirurgica A, Istituto Nazionale per lo Studio e la Cura dei Tumor, Milano.
Insights
Percutaneous transhepatic biliary drainage (PTBD) and cholangitis have complex relationships, with cholangitis sometimes complicating biliary drainage procedures. This review critically examines these correlations and discusses prevention strategies for septic complications.
Area of Science:
- Medical Imaging
- Interventional Radiology
- Hepatology
Context:
- Percutaneous transhepatic biliary drainage (PTBD) is a crucial intervention for biliary obstruction.
- Cholangitis, an inflammation of the bile ducts, presents a complex relationship with PTBD, sometimes arising as a complication.
- Understanding these correlations is vital for effective patient management.
Purpose:
- To critically review the clinical and radiological correlations between cholangitis and PTBD.
- To explore various pathogenetic hypotheses of cholangitis, including inflammation and cholestasis.
- To identify risk factors associated with cholangitis in patients undergoing PTBD.
Summary:
- The relationship between PTBD and cholangitis is multifaceted, with cholangitis potentially complicating the drainage procedure.
- Pathogenetic factors such as inflammation, cholestasis, and surgical manipulation contribute to cholangitis.
- Risk factors include impaired immune function, immunosuppression, extensive liver involvement, multiple ductal obstructions, chronic liver disease, and advanced age.
Impact:
- Provides a clinical-radiological perspective on PTBD-cholangitis interactions.
- Highlights key risk factors to guide preventative measures.
- Informs strategies for preventing and treating septic complications, including chemoprophylaxis and targeted antibiotic therapy.
Abstract:
The binomial PTBD-cholangitis often stands under different and sometimes even opposite relations. Among its indications the procedure lists, the treatment of cholangitis which, on the other hand, may be itself a complication of biliary drainage. The present work proposes a critical review of cholangitis-PTBD correlations, from an ordinary clinical-radiological point of view. Different pathogenetic hypothesis of cholangitis (inflammation, cholestasis, surgical manipulation) are discussed together with risk factors (impaired macrophagic-phagocytic system, immunosuppression, wide neoplastic liver involvement, multiple intrahepatic ductal obstructions, chronic liver diseases, aged patients, etc.). The authors also report about prevention and treatment of septic complications which must be carried out following technical and therapeutic strategies, such as chemoprophylaxis and focused antibiotic therapy according to bile culture samples, slow injection of small amounts of contrast medium, peripheral branches approach, gentle handling of catheters and guidewires, flushing with saline solutions and brushing of the catheter itself, and finally use of large gauge catheters in the presence of bile sludge.