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Post percutaneous transhepatic biliary intervention pancreatitis: rate and risk factors
Matthew J McGuinness1, Christopher Khoory2, Matthew Marshall-Webb2
1Department of General Surgery, North Shore Hospital, Waitematā District, Te Whatu Ora - Health New Zealand, Auckland, New Zealand; The University of Auckland, Auckland, New Zealand.
Background:
Percutaneous transhepatic biliary intervention (PTBI) is an established technique for managing biliary pathology. The incidence and predictors of post-PTBI pancreatitis remain poorly defined. This study evaluated the rate and risk factors for pancreatitis following PTBI.
Methods:
A single-centre retrospective cohort study was performed of adults undergoing PTBI between June 2020-June 2025. Pancreatitis was defined using the revised Atlanta criteria. Associations between procedural factors and post-PTBI pancreatitis were assessed using logistic regression.
Results:
A total of 503 PTBI procedures were performed in 201 patients. The mean age was 68.7 years (SD 13.6); 43% were female. Malignant obstruction accounted for 76% of procedures. Post-PTBI pancreatitis occurred after 35 procedures (7.0%). On multivariable analysis, first-time PTBI (aOR 6.2, 95% CI 2.8-15.2; p < 0.001) and stent placement (aOR 2.4, 95% CI 1.1-5.1; p = 0.023) were independently associated with pancreatitis. Pancreatitis occurred exclusively following procedures involving trans-ampullary instrumentation.
Discussion:
Pancreatitis is a clinically important complication following PTBI. First-time procedures and biliary stenting significantly increase risk, of pancreatitis. Procedural strategies that minimise ampullary manipulation should be considered to reduce pancreatitis risk.
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