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Bian C, Fang Y, Xia J, Shi L, Huang H, Xiong Q, Wu R, Zeng Z. Is percutaneous drainage better than endoscopic drainage in the management of patients with malignant obstructive jaundice? A meta-analysis of RCTs. Front Oncol 2023; 13:1105728. [PMID: 36793615 PMCID: PMC9923096 DOI: 10.3389/fonc.2023.1105728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/09/2023] [Indexed: 01/31/2023] Open
Abstract
To compare the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangial drainage (PTCD) in the treatment of malignant obstructive jaundice, a systematic review and meta-analysis of published studies was undertaken to assess the differences between the two procedures in terms of efficacy and safety. From November 2000 to November 2022, the Embase, PubMed, MEDLINE, and Cochrane databases were searched for randomized controlled trials (RCTs) on the treatment of malignant obstructive jaundice with ERCP or PTCD. Two investigators independently assessed the quality of the included studies and extracted the data. Six RCTs, including 407 patients, were included. The results of the meta-analysis showed that the overall technical success rate in the ERCP group was significantly lower than that in the PTCD group (Z=3.19, P=0.001, OR=0.31 (95% CI: 0.15-0.64)), but with a higher overall procedure-related complication incidence rate (Z=2.57, P=0.01, OR=0.55 (95% CI: 0.34-0.87)). The incidence of procedure-related pancreatitis in the ERCP group was higher than that in the PTCD group (Z=2.80, P=0.005, OR=5.29 (95% CI: 1.65-16.97)), and the differences were statistically significant. No significant difference was observed between the two groups when the clinical efficacy, postoperative cholangitis, and bleeding rate were compared.Both treatments for malignant obstructive jaundice were efficacious and safe. However, the PTCD group had a greater technique success rate and a lower incidence of postoperative pancreatitis.The present meta-analysis has been registered in PROSPERO.
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Affiliation(s)
- Cnogwen Bian
- Department of General Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China.,Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yuan Fang
- Department of General Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jun Xia
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lan Shi
- Department of the Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Hanfei Huang
- Department of General Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qiru Xiong
- Department of General Surgery, The Second, Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ruolin Wu
- Department of Hepatopancreatobiliary Surgery and Organ Transplantation Center, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhong Zeng
- Department of General Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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Dorcaratto D, Hogan NM, Muñoz E, Garcés M, Limongelli P, Sabater L, Ortega J. Is Percutaneous Transhepatic Biliary Drainage Better than Endoscopic Drainage in the Management of Jaundiced Patients Awaiting Pancreaticoduodenectomy? A Systematic Review and Meta-analysis. J Vasc Interv Radiol 2018; 29:676-687. [DOI: 10.1016/j.jvir.2017.12.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/21/2017] [Accepted: 12/21/2017] [Indexed: 02/08/2023] Open
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Choi SH, Gwon DI, Ko GY, Sung KB, Yoon HK, Shin JH, Kim JH, Kim J, Oh JY, Song HY. Hepatic arterial injuries in 3110 patients following percutaneous transhepatic biliary drainage. Radiology 2011; 261:969-75. [PMID: 21875851 DOI: 10.1148/radiol.11110254] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the frequency of hepatic arterial injury in 3110 patients who had undergone percutaneous transhepatic biliary drainage (PTBD) and assess the risk factors for hepatic arterial injury and the treatment outcome after transcatheter arterial embolization. MATERIALS AND METHODS A total of 3110 patients who underwent 3780 PTBDs between January 2003 and December 2008 were retrospectively assessed. This study was approved by the Institutional Review Board. The incidence of hepatic arterial injury was determined and the risk factors associated with it were analyzed by using univariate and multiple logistic regression analyses. Hepatic angiography was performed to identify the bleeding focus, followed by transcatheter arterial embolization. RESULTS Hepatic arterial injuries occurred after 72 (1.9%) of 3780 PTBDs. When adjusted for benign disease, perihepatic ascites, platelet count of 50,000/mm(3) or less, international normalization ratio of 1.5 or greater, and left-sided puncture, multiple logistic regression analysis showed that left-sided PTBD (odds ratio, 2.017; 95% confidence interval: 1.257, 3.236; P = .004) was the only independent risk factor associated with hepatic arterial injury. The technical and clinical success rates of transcatheter arterial embolization were 100% and 95.8%, respectively. Minor complications were observed in 58 (80.6%) patients, 55 (76.4%) of whom had hepatic ischemia and three (4.2%) of whom had focal hepatic infarction. No major complication was observed in any patient. CONCLUSION Hepatic arterial injury is a relatively rare complication of PTBD. Because left-sided PTBD is the only independent risk factor associated with hepatic arterial injury, right-sided PTBD is preferable unless technical difficulty or secondary intervention necessitates left-sided PTBD. Moreover, transcatheter arterial embolization is a safe and effective method for treating hepatic arterial injury following PTBD.
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Affiliation(s)
- Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea
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Weber A, Gaa J, Rosca B, Born P, Neu B, Schmid RM, Prinz C. Complications of percutaneous transhepatic biliary drainage in patients with dilated and nondilated intrahepatic bile ducts. Eur J Radiol 2008; 72:412-7. [PMID: 18926655 DOI: 10.1016/j.ejrad.2008.08.012] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Revised: 08/06/2008] [Accepted: 08/11/2008] [Indexed: 12/11/2022]
Abstract
Percutaneous transhepatic biliary drainage (PTBD) have been described as an effective technique to obtain biliary access. Between January 1996 and December 2006, a total of 419 consecutive patients with endoscopically inaccessible bile ducts underwent PTBD. The current retrospective study evaluated success and complication rates of this invasive technique. PTBD was successful in 410/419 patients (97%). The success rate was equal in patients with dilated and nondilated bile ducts (p=0.820). In 39/419 patients (9%) procedure related complications could be observed. Major complications occurred in 17/419 patients (4%). Patients with nondilated intrahepatic bile ducts had significantly higher complication rates compared to patients with dilated intrahepatic bile ducts (14.5% vs. 6.9%, respectively [p=0.022]). Procedure related deaths were observed in 3 patients (0.7%). In conclusion, percutaneous transhepatic biliary drainage is an effective procedure in patients with dilated and nondilated intrahepatic bile ducts. However, patients with nondilated intrahepatic bile ducts showed a higher risk for procedure related complications.
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Affiliation(s)
- Andreas Weber
- Department of Gastroenterology, Technical University of Munich, Germany
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Fidelman N, Bloom AI, Kerlan RK, Laberge JM, Wilson MW, Ring EJ, Gordon RL. Hepatic arterial injuries after percutaneous biliary interventions in the era of laparoscopic surgery and liver transplantation: experience with 930 patients. Radiology 2008; 247:880-6. [PMID: 18487540 DOI: 10.1148/radiol.2473070529] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To retrospectively determine if patients with a history of intraoperative bile duct injury or liver transplantation have an increased risk for arterial injury (AI) during percutaneous transhepatic cholangiography (PTC) and percutaneous transhepatic biliary drainage (PTBD) compared with the risk of AI established in the 1970s and 1980s. MATERIALS AND METHODS This study was approved by the committee on human research and was deemed compliant with the Health Insurance Portability and Accountability Act. The informed consent requirement was waived. Records of 1394 procedures (307 PTCs, 1087 PTBDs) performed in 930 patients (445 male, 485 female; age range, 4 months to 99 years) over the past 13 years were retrospectively reviewed. The rate of AI was determined, and demographic, pathologic, technical, and laboratory variables were tested for association with increased risk of AI by using generalized estimating equation analysis. RESULTS AIs were encountered after 30 (2.2%) biliary procedures. No significant difference in the rate of AI was seen among the groups of patients with malignant biliary obstruction (1.8%), history of bile duct injury (2.2%), or complications of liver transplantation (2.6%). Patients who underwent PTBD had a higher risk of AI than did patients who underwent PTC (2.6% vs 0.7%); however, this difference was not significant (P = .06). Ongoing hemobilia was seen in 26 (87%) of the patients, which made it the most common sign of AI, and it had a 94% positive predictive value for AI. A postprocedure decrease in the hematocrit level of more than 13% was seen only in the setting of AI, and it occurred in only three (10%) of patients with AIs. CONCLUSION PTC and PTBD performed for management of bile duct injury and complications of liver transplantation are not associated with an increased risk of hepatic AIs compared with the risk of AI reported in the 1970s and 1980s.
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Affiliation(s)
- Nicholas Fidelman
- Department of Radiology, University of California, San Francisco, 505 Parnassus Ave, Room M-361, San Francisco, CA 94143, USA
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MINE T. Biliary Stenting: Transduodenal Approach. Dig Endosc 1999. [DOI: 10.1111/j.1443-1661.1999.tb00185.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Tetsuya MINE
- Fourth Department of Internal Medicine, University of Tokyo School of Medicine, Tokyo, Japan
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Affiliation(s)
- S M Wu
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
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Tumors at the Biliary Confluence: How To Choose Between External Drainage, Endoprostheses, Stents, and Radiation. J Vasc Interv Radiol 1997. [DOI: 10.1016/s1051-0443(97)70048-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Ramesh VS, Kochhar R, Garg SK, Wig JD, Gupta NM. Antipyrine elimination test as a guideline for selecting patients for transhepatic biliary drainage. J Gastroenterol Hepatol 1990; 5:219-22. [PMID: 2103402 DOI: 10.1111/j.1440-1746.1990.tb01619.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Antipyrine elimination halflife (AP t1/2) was studied in 18 patients with obstructive jaundice along with routine liver function tests 24-48 h before the expected time of percutaneous transhepatic biliary drainage (PTBD). To see if it is possible to predict the outcome of PTBD, various predrainage parameters were correlated with the postdrainage bilirubin clearance after 1 week of drainage. Predrainage AP t1/2 correlated best with bilirubin clearance (r = 0.775, P less than 0.01) compared with predrainage serum bilirubin, alkaline phosphatase and serum proteins/albumin. Eight patients had AP t1/2 less than 15 h, while 10 had AP t1/2 greater than 15 h. Patients with AP t1/2 less than 15 h had significantly faster recovery after PTBD than patients with AP t1/2 greater than 15 h. If PTBD can be restricted to those with AP t1/2 less than 15 h, the advantages of preliminary PTBD can be achieved with minimum complications. Thus, estimation of AP t1/2 may aid in the selection of patients with obstructive jaundice who are likely to benefit by preliminary biliary decompression.
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Affiliation(s)
- V S Ramesh
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Since 1983, percutaneous transhepatic cholangioscopy has been performed in 50 patients for both therapeutic and diagnostic purposes. Percutaneous transhepatic cholangioscopy was used to evaluate the nature of obstructive jaundice in 15 patients and bile duct stones were removed in 35 patients, 27 of whom also had intrahepatic duct stones. The overall success rate for stone removal was 80 per cent. Complications were few with no mortality. Emergency surgery was necessary in two patients, one for subphrenic haematoma, the other for a bile leak. Percutaneous transhepatic cholangioscopy is an effective and safe method for management of biliary stones and is a useful procedure for establishing the diagnosis of obstructive jaundice.
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Affiliation(s)
- M F Chen
- Department of Surgery, Chang Gung Memorial Hospital, Taiwan, Republic of China
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Szabo S, Mendelson MH, Mitty HA, Bruckner HW, Hirschman SZ. Infections associated with transhepatic biliary drainage devices. Am J Med 1987; 82:921-6. [PMID: 3578361 DOI: 10.1016/0002-9343(87)90153-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
To determine the infectious complications associated with transhepatic biliary drainage devices, an analysis of the records of 38 patients who underwent placement of a pigtail catheter (n = 11), a Ring catheter/feeding tube (n = 13), or a Carey-Coons endoprosthesis (n = 15) was carried out. Nineteen infectious events occurred in 38 patients with 39 biliary devices. Infections consisted of bacteremia, cholangitis with and without documented bacteribilia, and intrahepatic abscesses and were frequently associated with obstruction (66.7 percent of infectious episodes). The most frequent organisms isolated from blood were Escherichia coli and Pseudomonas aeruginosa, and the most frequent organisms isolated from bile were P. aeruginosa, Klebsiella pneumoniae and Streptococcus faecalis. Trends for more frequent occurrence of neoplasms involving the gallbladder or biliary tract, recent surgical procedures and catheter manipulations in infected as compared with noninfected patients, and a delayed time to infection were noted in patients with an endoprosthesis.
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Pain JA, Cahill CJ, Bailey ME. Perioperative complications in obstructive jaundice: therapeutic considerations. Br J Surg 1985; 72:942-5. [PMID: 3936565 DOI: 10.1002/bjs.1800721203] [Citation(s) in RCA: 104] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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McPherson GA, Benjamin IS, Habib NA, Bowley NB, Blumgart LH. Percutaneous transhepatic drainage in obstructive jaundice: advantages and problems. Br J Surg 1982; 69:261-4. [PMID: 6803864 DOI: 10.1002/bjs.1800690511] [Citation(s) in RCA: 89] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This study is a critical prospective assessment of 37 patients with obstructive jaundice, treated by percutaneous transhepatic biliary drainage. The median duration of drainage was 18 days (range 44-55), and during this period clearance of bilirubin and improvement in creatinine clearance were obtained. Only 10 patients gained weight. Three patients required early laparotomy. Thirty-three patients underwent definitive surgery. Of these, 8 died without leaving hospital. The incidence of infection rose during drainage, and infected bile was clinically significant. Two deaths were associated with infection, arising in the drainage system, producing intrahepatic abscesses around the drain track. While the evidence for a staged approach in the severely ill patient with obstructive jaundice is substantial, the procedure of percutaneous transhepatic tubal drainage carries significant hazards, underemphasized in previous reports. Further controlled assessment is required before this technique is accepted as the initial best option for decompression of the obstructed biliary tract.
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