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Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
A review of percutaneous transhepatic biliary drainage at a tertiary referral centre
H Asadi1, R Hollingsworth2, K Pennycooke2
1Interventional Radiology Service, Department of Radiology, Beaumont Hospital, Beaumont Rd, Beaumont, Dublin 9, Ireland; School of Medicine, Faculty of Health, Deakin University, Pigdons Road, Waurn Ponds, VIC 3216, Australia.
Insights
Percutaneous biliary drainage (PBD) is a safe and effective procedure for managing biliary conditions. This study found acceptable morbidity and mortality rates for PBD in Beaumont Hospital.
Area of Science:
- Interventional Radiology
- Gastroenterology
- Hepatology
Background:
- Percutaneous biliary drainage (PBD) is a crucial intervention for biliary obstruction.
- Evaluating the safety and efficacy of PBD is essential for patient outcomes.
- Data on PBD outcomes in specific healthcare settings can inform clinical practice.
Purpose of the Study:
- To assess the 30-day morbidity and mortality associated with percutaneous biliary drainage (PBD) procedures.
- To review PBD procedures performed at Beaumont Hospital, Dublin, over a six-year period.
- To compare outcomes with existing literature on PBD.
Main Methods:
- A retrospective review of 193 PBD procedures in 119 patients over six years.
- Analysis of patient demographics, indications (stone disease, malignancy, other), and procedural techniques.
- Inclusion of antibiotic prophylaxis, hydration, and gelfoam embolization of tracts.
Main Results:
- High technical success rate of 97% with significant bilirubin reduction.
- 30-day mortality rate of 10.9% and overall morbidity rates of 5% major and 7.6% minor.
- Major complications included sepsis, hemorrhage, and renal failure; minor complications included infection and bile leak.
Conclusions:
- Percutaneous biliary drainage (PBD) with stent insertion is a safe and effective intervention.
- The procedure demonstrated acceptable morbidity and mortality rates comparable to other studies.
- Findings support the continued use of PBD in Beaumont Hospital for appropriate indications.
Aim:
To review percutaneous biliary drainage (PBD) procedures performed in Beaumont Hospital, Dublin, Ireland, over a 6-year period, to determine the 30-day morbidity and mortality.
Materials And Methods:
A total of 119 patients undergoing 193 PBD procedures were identified over a 6 year period. Of the patients, 6.7% (eight patients) had stone disease, 63% (75 patients) had a malignancy, and the remainder were diagnosed with other conditions. Standard techniques of PBD and biliary stent insertion were applied, with 73 patients (61%) having same-day procedures and all undergoing gelfoam embolisation of percutaneous tracts. All patients received intravenous prophylactic antibiotics and intravenous hydration prior to PBD.
Results:
The technical success rate was 97%, with a mean drop of 105 mmol/l between pre- and post-procedure bilirubin. Thirty-day mortality was 10.9% (13 deaths), with major and minor morbidities of 5% (six patients) and 7.6% (nine patients), respectively. Major complications included sepsis in two patients, major haemorrhage in two patients, and renal failure in two patients. Minor complications included infection in seven patients, bile leak causing self-limiting pain in one patient, and minor haemorrhage in one patient.
Conclusion:
The study confirms that PBD and stent insertion is a safe and effective technique in Beaumont Hospital, associated with an overall acceptable morbidity and mortality comparable with other studies.
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