Complication rates of percutaneous biliary drainage in the presence of ascites

Ascites is a relative contraindication to percutaneous biliary drainage (PBD), but patients with biliary obstruction presenting with ascites may still undergo PBD insertion. We hypothesized that ascites increases the major complication rate of PBD.

PBDs placed between January 2005 and August 2016 were identified (n = 491). Etiology and location of obstruction, the presence, and distribution of ascites based on abdominal imaging within 2 weeks of PBD, INR, WBCE, and peri-procedural complications were reviewed in the EMR.

A total of 491 PBD were placed during the study period of which 26.2% had ascites (n = 129), and 73.7% did not have ascites (n = 362). Ascites was categorized as perihepatic in 41 patients (32%), diffuse in 82 patients (64%), and non-perihepatic in 6 patients (4%). Overall, a significantly higher rate of major complications occurred in patients with ascites (19%) compared to that in patients without ascites (7.7%, P = 0.0004). Diffuse ascites was associated with a significantly higher major complication rate (26%) when compared to perihepatic ascites (7.3%, P = 0.014). In ascites patients, no association between the etiology of biliary obstruction or laterality of the PBD and the rate of major complications was identified.

The major complication rate in patients with ascites not only exceeds SIR suggested threshold of 10% but is also significantly higher than that patients without ascites. The distribution of ascites had a significant effect on complication rate, with diffuse ascites being associated with increased major complication rates compared to those with perihepatic. These findings suggest careful consideration of patients for PBD with ascites, particularly diffuse ascites.