Experience Matters: Impact on Technical Success and Complication Rate in Percutaneous Transhepatic Biliary Drainage

To investigate factors influencing the success and complication rate of percutaneous transhepatic biliary drainage (PTBD).

PTBD procedures between 2017 and 2022 were enrolled retrospectively. Success rate, complications, and technical considerations were compared using Mann-Whitney U-, X²-, and Fishers exact tests. The influence of the study center's experience (training-effect) on success and complication rates was assessed by linear regression categorized by year.

In 398 patients, 499 PTBD procedures (337 men; mean age 66.2 +/- 12.5 years) were carried out, with a success rate of 83.2% (415/499). PTBD in dilated bile ducts was more successful than in non-dilated bile ducts (90.0%; 316/340 vs. 68.6%; 109/159; p < 0.001), with e.g. lower radiation doses (2787.52 +/- 4012.72 cGy*cm² vs. 4679.25 +/- 4663.55 cGy*cm²; p < 0.001), and shorter total procedure time (33.42 +/- 24.03 min vs. 41.09 +/- 27.21 min; p < 0.001). Complications occurred in 34/499 (6.8%) procedures (major complications n = 25/34) with no significant difference in bile duct width. Right-sided PTBD revealed more complications (9.0%; 30/332 vs. 2.4%; 4/166; p = 0.006) and higher radiation doses (3679.47 +/- 4571.71 cGy*cm2 vs. 2819.01 +/- 3724.92 cGy*cm2; p = 0.001) than left-sided approaches. Linear regression showed a significant continuous increase in the technical success rate of 3.0% per year (2017-2022; 72.5%; 78.5%; 82.2%; 85.0%; 89.0%; 87.5%; p = 0.005), while the overall complication rate remained unaffected (p = 0.364).

Medical centers adopting PTBD procedures can potentially increase their success rate significantly within a short period of time. PTBD is a safe procedure, with left-sided approaches showing lower complication rates and radiation exposure, underscoring their often-underestimated advantages in clinical practice.