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Ten years single center experience in percutaneous transhepatic decompression of biliary tree in patients with malignant obstructive jaundice.
Adv Clin Exp Med. 2012 Sep-Oct; 21(5):621-32.AC

Abstract

BACKGROUND

Percutaneous transhepatic biliary drainage (PTBD) is a method of biliary tree decompression, applied as palliative treatment in patients with malignant biliary tree critical stenosis/obstruction, but also as a potentially curative treatment in patients with non-malignant biliary tree stenosis. Novel instrumentation dedicated to PTBD has been designed in recent years, which makes it possible to perform more advanced procedures in patients with severe extensive malignant biliary tree stenosis/obstruction.

OBJECTIVES

The first primary goal of the study was to compare both the rate and types of short- and long-term complications in patients who had undergone PTBD between 2000 and 2006 with patients treated between 2007 and 2011. The second primary goal of the study was to work out an original algorithm of efficient management in patients undergoing PTBD. An additional goal was to assess the efficacy of PTBD and the overall survival of the patients.

MATERIAL AND METHODS

One-hundred twenty-eight consecutive PTBD procedures performed between 2000 and 2006 in patients with malignant biliary jaundice were analyzed retrospectively. Similarly, retrospective analysis of 73 consecutive procedures in patients with malignant biliary jaundice performed between 2007 and 2011 was carried out. Subsequently, the results of both subsets were compared to each other. The PTBD procedure was guided fluoroscopy each time. PTBD involved external biliary drainage and/or stenting of the strictured/occluded segments of extra- and intrahepatic biliary ducts.

RESULTS

The analysis demonstrated a statistically significant decrease in the overall incidence of short- and long-term complications in patients undergoing PTBD in 2007-2011 in comparison to the subset treated in 2000-2006. Among the early complications, a significant decrease in sub- and pericapsular contrasted bile leaks was shown. The evaluation of long-term complications demonstrated lower incidence of the falling out of the draining catheter. The implementation of novel instrumentation made it possible to perform biliary stenting in 63.7% cases of common bile duct (CBD) obstruction (vs. 37.5% in procedures carried out in 2000-2006). However, no statistically significant difference in survival between the two analyzed subsets was demonstrated.

CONCLUSIONS

The analysis of rate and types of complications made it possible to establish authors own algorithm of management in different types of biliary obstructions and strictures. The modification of procedure technique, pos-tinterventional management and usage of the new generation of low-profile instrumentation for percutaneous access dedicated to PTBD has resulted in a significant reduction of the complication rate in the last 5 years. Higher frequency of CBD stenting improves the quality of life in this subset of patients.

Authors+Show Affiliations

Chair of Radiology, Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Poland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23356199

Citation

Garcarek, Jerzy, et al. "Ten Years Single Center Experience in Percutaneous Transhepatic Decompression of Biliary Tree in Patients With Malignant Obstructive Jaundice." Advances in Clinical and Experimental Medicine : Official Organ Wroclaw Medical University, vol. 21, no. 5, 2012, pp. 621-32.
Garcarek J, Kurcz J, Guziński M, et al. Ten years single center experience in percutaneous transhepatic decompression of biliary tree in patients with malignant obstructive jaundice. Adv Clin Exp Med. 2012;21(5):621-32.
Garcarek, J., Kurcz, J., Guziński, M., Janczak, D., & Sasiadek, M. (2012). Ten years single center experience in percutaneous transhepatic decompression of biliary tree in patients with malignant obstructive jaundice. Advances in Clinical and Experimental Medicine : Official Organ Wroclaw Medical University, 21(5), 621-32.
Garcarek J, et al. Ten Years Single Center Experience in Percutaneous Transhepatic Decompression of Biliary Tree in Patients With Malignant Obstructive Jaundice. Adv Clin Exp Med. 2012 Sep-Oct;21(5):621-32. PubMed PMID: 23356199.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ten years single center experience in percutaneous transhepatic decompression of biliary tree in patients with malignant obstructive jaundice. AU - Garcarek,Jerzy, AU - Kurcz,Jacek, AU - Guziński,Maciej, AU - Janczak,Dariusz, AU - Sasiadek,Marek, PY - 2013/1/30/entrez PY - 2013/1/30/pubmed PY - 2013/2/13/medline SP - 621 EP - 32 JF - Advances in clinical and experimental medicine : official organ Wroclaw Medical University JO - Adv Clin Exp Med VL - 21 IS - 5 N2 - BACKGROUND: Percutaneous transhepatic biliary drainage (PTBD) is a method of biliary tree decompression, applied as palliative treatment in patients with malignant biliary tree critical stenosis/obstruction, but also as a potentially curative treatment in patients with non-malignant biliary tree stenosis. Novel instrumentation dedicated to PTBD has been designed in recent years, which makes it possible to perform more advanced procedures in patients with severe extensive malignant biliary tree stenosis/obstruction. OBJECTIVES: The first primary goal of the study was to compare both the rate and types of short- and long-term complications in patients who had undergone PTBD between 2000 and 2006 with patients treated between 2007 and 2011. The second primary goal of the study was to work out an original algorithm of efficient management in patients undergoing PTBD. An additional goal was to assess the efficacy of PTBD and the overall survival of the patients. MATERIAL AND METHODS: One-hundred twenty-eight consecutive PTBD procedures performed between 2000 and 2006 in patients with malignant biliary jaundice were analyzed retrospectively. Similarly, retrospective analysis of 73 consecutive procedures in patients with malignant biliary jaundice performed between 2007 and 2011 was carried out. Subsequently, the results of both subsets were compared to each other. The PTBD procedure was guided fluoroscopy each time. PTBD involved external biliary drainage and/or stenting of the strictured/occluded segments of extra- and intrahepatic biliary ducts. RESULTS: The analysis demonstrated a statistically significant decrease in the overall incidence of short- and long-term complications in patients undergoing PTBD in 2007-2011 in comparison to the subset treated in 2000-2006. Among the early complications, a significant decrease in sub- and pericapsular contrasted bile leaks was shown. The evaluation of long-term complications demonstrated lower incidence of the falling out of the draining catheter. The implementation of novel instrumentation made it possible to perform biliary stenting in 63.7% cases of common bile duct (CBD) obstruction (vs. 37.5% in procedures carried out in 2000-2006). However, no statistically significant difference in survival between the two analyzed subsets was demonstrated. CONCLUSIONS: The analysis of rate and types of complications made it possible to establish authors own algorithm of management in different types of biliary obstructions and strictures. The modification of procedure technique, pos-tinterventional management and usage of the new generation of low-profile instrumentation for percutaneous access dedicated to PTBD has resulted in a significant reduction of the complication rate in the last 5 years. Higher frequency of CBD stenting improves the quality of life in this subset of patients. SN - 1899-5276 UR - https://www.unboundmedicine.com/medline/citation/23356199/Ten_years_single_center_experience_in_percutaneous_transhepatic_decompression_of_biliary_tree_in_patients_with_malignant_obstructive_jaundice_ L2 - http://www.advances.am.wroc.pl/pdf/2012/21/5/621.pdf DB - PRIME DP - Unbound Medicine ER -