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Updated: Aug 25, 2025
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
The Clinical Benefit of Percutaneous Transhepatic Biliary Drainage for Malignant Biliary Tract Obstruction
Ivan Nikolić1,2, Jelena Radić1,2, Andrej Petreš3
1Oncology Institute of Vojvodina, Department of Medical Oncology, Put Doktora Goldmana 4, 21204 Sremska Kamenica, Serbia.
Insights
Percutaneous transhepatic biliary drainage (PTBD) helps patients with malignant biliary obstruction. Achieving adequate bilirubin decline after PTBD improves survival, especially for those restarting chemotherapy.
Area of Science:
- Interventional Radiology
- Oncology
- Hepatology
Background:
- Malignant proximal biliary obstruction causes jaundice and can impede cancer treatment.
- Percutaneous transhepatic biliary drainage (PTBD) is a procedure to decompress the biliary system.
- Patient outcomes after PTBD vary, particularly concerning the ability to resume chemotherapy.
Purpose of the Study:
- To evaluate clinical outcomes of PTBD in patients with malignant biliary obstruction.
- To assess the impact of adequate bilirubin decline (ABD) on survival and chemotherapy resumption.
- To identify factors associated with better outcomes after PTBD.
Main Methods:
- Retrospective analysis of 89 patients undergoing PTBD over six years.
- Classification of patients based on achieving adequate bilirubin decline (ABD) for chemotherapy.
- Kaplan-Meier survival analysis and multivariate logistic regression using MEDCALC software.
Main Results:
- 58.4% of patients had good performance status (ECOG 0/1) and underwent PTBD to restart chemotherapy.
- Only 23.0% achieved bilirubin normalization, with 15.4% actually receiving chemotherapy.
- Median survival was 9 weeks overall, but 64 weeks for patients with ABD who received chemotherapy. Best outcomes were seen in patients with good performance status, low bilirubin/LDH, and elevated leukocytes.
Conclusions:
- PTBD is a valuable decompression technique for malignant biliary obstruction.
- Achieving adequate bilirubin decline post-PTBD is crucial for enabling chemotherapy and improving survival.
- Patient performance status and specific laboratory values at the time of PTBD are predictive of outcomes.
Abstract:
Percutaneous transhepatic biliary drainage (PTBD) is a decompression procedure for malignant proximal biliary obstruction. In this research, over a six-year period, 89 patients underwent PTBD procedure for jaundice caused by malignant disease to restart chemotherapy or for palliative intent. Clinical outcomes after PTBD procedure in the two groups of patients, according to the adequate bilirubin decline (ABD) needed for subsequent chemotherapy, are presented in this paper. Survival and logistic regression were plotted and compared using Kaplan−Meier survival multivariate analysis with a long-range test. Results were processed by MEDCALC software. In the series, 58.4% (52/89) of patients were in good performance status (ECOG 0/1), and PTBD was performed with the intention to (re)start chemotherapy. The normalization of the bilirubin level was seen in 23.0% (12/52), but only 15.4% (8/52) received chemotherapy. The median survival time after PTBD was 9 weeks. In patients with ABD that received chemotherapy, the median survival time was 64 weeks, with 30-day mortality of 27.7%, and 6.4% of death within 7 days. The best outcome was in patients with good performance status (ECOG 0−1), low bilirubin (<120 µmol/L) and LDH (<300 µmol/L) levels and elevated leukocytes at the time of the procedures. PTBD is considered in ABD patients who are candidates for chemotherapy.
