Safety of Early Catheter Removal After Percutaneous Transhepatic Biliary Drainage in Acute Cholangitis: A...

Background/Objectives: No current guideline specifies the timing of catheter removal after percutaneous transhepatic biliary drainage (PTBD). This study aimed to evaluate the clinical outcomes of early PTBD catheter removal after resolution of biliary obstruction in patients with acute cholangitis. Methods: This retrospective, single-center cohort study included 357 patients with acute cholangitis who underwent PTBD. Patients were divided into an early removal group (7-10 days, n = 199) and a late removal group (>10 days, n = 158) according to the timing of PTBD catheter removal. Clinical outcomes after catheter removal were compared between the two groups. Results: There was no significant difference between the two groups in the complication rate after PTBD catheter removal (2.5%; 95% CI, 1.1-5.7% in the early group vs. 1.9%; 95% CI, 0.6-5.4% in the late group; p > 0.999). In the early group, the most common complication was biloma (n = 3, 1.5%), followed by bile peritonitis (n = 1, 0.5%) and hemobilia (n = 1, 0.5%). In the late removal group, biloma, bile peritonitis, and hemobilia each occurred in one patient (0.6%). The total length of hospital stay was significantly shorter in the early group than in the late group (12 days [IQR, 10-15] vs. 17 days [IQR, 14-24]; p < 0.001). In exploratory multivariable analysis, early removal was associated with a 5.36-day shorter adjusted conditional median hospital stay than late removal (95% CI, 3.63-7.08; p < 0.001). Conclusions: Early PTBD catheter removal 7-10 days after placement appears to be feasible and was associated with a low rate of post-removal complications in appropriately selected patients with acute cholangitis, provided that predefined removal criteria are met.