Percutaneous Transhepatic Biliary Intervention for The Management of Malignant Hilar Biliary Obstruction

This study evaluated the short-term safety and effectiveness of percutaneous transhepatic biliary drainage (PTBD) for a malignant hilar biliary obstruction (MHBO).

The data from 112 patients with MHBO who underwent PTBD between January 2019 and June 2024 were analyzed retrospectively. All MHBO was confirmed pathologically. Technical success was defined as the placement of a drainage tube within the biliary tract. Clinical success was defined as a decrease in the total bilirubin level of ≥20% within seven days post-procedure. The 30-day morbidity, mortality, and re-intervention were documented. One interventional radiologist with 15 years of experience performed all procedures.

The average age was 62.6±12.3 years (range, 28-91 years), and the female-to-male ratio was 2:3. The most common etiology of MHBO was cholangiocarcinoma (68.8%). The Bismuth-Corlette classification scores were as follows: type 1 (17.9%), type 2 (23.2%), type 3A (25.9%), type 3B (16.0%), and type 4 (17.0%). The technical success rate was 99.1%; 41.4% of PTBD were bilateral, and 82% were internal-external drainage. Preoperative drainage and palliative drainage were indicated in 28.6% and 71.4% of cases, respectively. Biliary stents were implanted in 39 patients (35.1%), including 51.3% unilateral stents, 23.1% Y-stents, 20.5% kissing stents, and 5.1% T-stents. The clinical success rate was 69.6%. The minor complication rate was 18.8%. The 30-day re-intervention and mortality rates were 24.1% and 1.8%, respectively.

PTBD was safe and effective in managing MHBO. Further study of this specific subgroup and long-term follow-up is warranted.