[Percutaneous transhepatic biliary drainage in obstructive jaundice]

Area of Science:

• Gastroenterology
• Interventional Radiology
• Hepatobiliary Surgery

Background:

• Obstructive jaundice presents a significant clinical challenge, often requiring effective palliation or preparation for definitive treatment.
• Hepatic hilum carcinoma, pancreatic carcinoma, and liver abscesses are common causes of obstructive jaundice necessitating timely intervention.

Purpose of the Study:

• To evaluate the efficacy and safety of Percutaneous Transhepatic Cholangiography (PTC) and Percutaneous Transhepatic Cholangiography-Drainage (PTC-D) in patients with obstructive jaundice.
• To assess the diagnostic and therapeutic utility of PTC-D in managing complex biliary obstructions.

Main Methods:

• PTC was performed in 86 patients with obstructive jaundice.
• PTC-D was attempted in 16 patients, focusing on catheterization of the intrahepatic biliary tree and establishing biliary flow.
• Catheter placement and drainage duration were monitored, alongside clinical outcomes and complication rates.

Main Results:

• PTC-D successfully catheterized the intrahepatic biliary tree in 15 patients, with good biliary flow achieved in 10.
• Significant improvements were observed: 83.33% general improvement, 100% cholestasis reduction, 75% sepsis reduction, and notable decrease/disappearance of itching (40%/60%).
• Complications included pain during guide wire insertion (18.75%) and transitory hemobilia (31.21%).

Conclusions:

• PTC-D is a valuable procedure for obstructive jaundice, particularly in patients with hepatic hilum or pancreatic carcinoma, and liver abscesses.
• The technique effectively palliates symptoms and improves patient condition, facilitating subsequent definitive therapies such as surgery, prosthesis, or external-internal biliary drainage.
• PTC-D offers a precise indication in managing transitory obstructive jaundice, enhancing patient preparedness for definitive treatment strategies.