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Verma A, Kumar I, Singh PK, Kumar T, Pandey D. Technical Feasibility, Short-Term Patency, Safety, and Efficacy of Percutaneously Delivered Double Pig-Tail Stent for Palliation of Unresectable Biliary Malignancies. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2022. [DOI: 10.1055/s-0042-1758049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Purpose The aim of this study was to evaluate the technical feasibility, complication rate, and efficacy of percutaneously delivered plastic biliary stent, compared with that of internal–external biliary drainage catheter.
Methods Patients with unresectable malignant biliary obstruction were included who underwent percutaneous transhepatic biliary drainage and double pigtail plastic stenting (DPT-PS) or internal–external biliary drainage catheter in 15 months' duration.
Results Seventy-seven patients were included in the study who underwent DPT-PS (n = 37) or internal external drainage catheter placement (n = 40). Overall, the technical success rate for percutaneous plastic stenting was 92.5% and technical success rate for primary stenting at the time of initial puncture was 62%. The incidence of fever and hemobilia was similar across the two groups, whereas bile leakage in the perihepatic space and through the skin at puncture site was higher in patients with internal–external drainage catheter. Both the techniques were effective in reducing the bilirubin levels of patients. Re-intervention was done in five patients in DPT-PS and six patients with ring biliary catheter.
Conclusion DPT-PS may be used as a viable cost-efficient alternative for unresectable biliary malignancies with low post-procedure life expectancy
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Affiliation(s)
- Ashish Verma
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ishan Kumar
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | | | - Tarun Kumar
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Durgatosh Pandey
- Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Institute, Varanasi, Uttar Pradesh, India
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Prognostic nomogram for acute pancreatitis after percutaneous biliary stent insertion in patients with malignant obstruction. BMC Gastroenterol 2022; 22:449. [PMCID: PMC9639303 DOI: 10.1186/s12876-022-02554-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Objective
This study aimed to develop and validate a nomogram to predict the risk of pancreatitis after percutaneous transhepatic biliary stent insertion (PTBS) in patients with malignant biliary obstruction (MBO).
Materials and methods
We enrolled 314 patients who underwent PTBS for MBO from March 2016 to July 2021 in this retrospective study. We used univariate analysis to identify potential risk factors, while a multivariate logistic regression model was employed to establish a nomogram for predicting the risk of pancreatitis. The discrimination and calibration of the nomogram were evaluated by estimating the area under the receiver operator characteristic curve (AUC) and by bootstrap resampling and visual inspection of the calibration curve. The clinical utility of the nomogram was assessed using decision curve analysis (DCA).
Results
After the procedure, 41 (13.1%) patients developed pancreatitis. Based on multivariate logistic regression analysis, young age (OR = 2.57, 95% CI 1.16 to 5.69), stent insertion across the papilla (OR = 6.47, 95% CI 2.66 to 15.70), and visualization of the pancreatic duct (OR = 15.40, 95% CI 6.07 to 39.03) were associated with an elevated risk of pancreatitis. Importantly, the performance of the nomogram was satisfactory, with an identical AUC (0.807, 95% CI 0.730 to 0.883) and high-level agreement between predicted and observed probabilities as suggested in calibration curves. The DCA curve subsequently confirmed the clinical utility.
Conclusion
A predictive nomogram for pancreatitis after PTBS in patients with MBO was successfully established in the present study.
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Yang Y, Liu RB, Liu Y, Jiang HJ. Incidence and risk factors of pancreatitis in obstructive jaundice patients after percutaneous placement of self-expandable metallic stents. Hepatobiliary Pancreat Dis Int 2020; 19:473-477. [PMID: 32291180 DOI: 10.1016/j.hbpd.2020.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 03/12/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Percutaneous transhepatic biliary drainage is an alternative treatment for patients with malignant distal biliary obstruction. The aim of this study was to investigate the occurrence of pancreatitis in patients who had undergone percutaneous placement of a biliary stent and to assess the risk factors for pancreatitis and the treatment outcomes. METHODS From January 2010 to October 2016, 980 patients in our hospital who underwent percutaneous placements of self-expandable metallic stents for obstructive jaundice were retrospectively analyzed. The incidence of pancreatitis and risk factors were assessed by univariate and multivariate logistic regression analysis. Therapeutics, such as somatostatin, which were also adminstrated to release the symptom and promote the restoration of normal function of pancreas, were also analyzed. RESULTS Pancreatitis occurred in 45 (4.6%) patients. One patient died from severe acute pancreatitis. Multivariate logistic regression analysis showed that common bile duct stent placement was the only independent risk factor that related to pancreatitis (odds ratio = 2.096, 95% CI: 1.248-5.379; P = 0.002). By using somatostatin, the concentrations of serum amylase and lipase were decreased in 44 patients with pancreatitis. No major complications were found during the treatment. CONCLUSIONS Pancreatitis is a relatively low complication of percutaneous placement of biliary stents. The common bile duct stent placement is the only independent risk factor that related to pancreatitis. In this case, the percutaneous transhepatic biliary drainage is a preferred method for treatment. Furthermore, somatostatin is a secure and efficacious method to release the symptom and promote the restoration of pancreatic function.
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Affiliation(s)
- Yi Yang
- Department of Radiology, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China; Department of Interventional Radiology, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Rui-Bao Liu
- Department of Interventional Radiology, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Yan Liu
- Department of Interventional Radiology, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Hui-Jie Jiang
- Department of Radiology, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China.
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Houghton EJ, Invernizzi E, Acquafresca P, Palermo M, Giménez ME. RISK OF BLEEDING COMPLICATIONS IN PERCUTANEOUS BILIARY DRAINAGE: THE PARADOX OF THE NORMAL HEMOSTASIS. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2019; 32:e1454. [PMID: 31644674 PMCID: PMC6812145 DOI: 10.1590/0102-672020190001e1454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/02/2019] [Indexed: 02/08/2023]
Abstract
Background:
Percutaneous biliary drainage is a safe procedure. The risk of bleeding
complications is acceptable. Frequently, patients with biliary obstructions
usually have coagulation disorders thus increasing risk of bleeding. For
this reason, patients should always fit the parameters of hemostasis.
Aim:
To determine whether the percentage of bleeding complications in
percutaneous biliary drainage is greater in adults with corrected hemostasis
prior to the procedure regarding those who did not require any.
>Methods
: Prospective, observational, transversal, comparative by
independent samples (unpaired comparison). Eighty-two patients with
percutaneous biliary drainage were included. The average age was 64±16 years
(20-92) being 38 male and 44 female. Patients who presented altered
hemostasis were corrected and the presence of bleeding complications was
evaluated with laboratory and ultrasound.
Results:
Of 82 patients, 23 needed correction of hemostasis. The approaches performed
were: 41 right, 30 left and 11 bilateral. The amount of punctures on average
was 3±2. There were 13 (15.8%) bleeding complications, 12 (20%) in
uncorrected and only one (4.34%) in the corrected group with no statistical
difference. There were no differences in side, number of punctures and type
of drainage, but number of passes and the size of drainage on the right side
were different. There was no related mortality.
Conclusion:
Bleeding complications in patients requiring hemostasis correction for a
percutaneous biliary drainage was not greater than in those who did not
require any.
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Affiliation(s)
- Eduardo Javier Houghton
- DAICIM Foundation.,Hospital Bernardino Rivadavia.,Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Mariano Palermo
- DAICIM Foundation.,Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Mariano E Giménez
- DAICIM Foundation.,Universidad de Buenos Aires, Buenos Aires, Argentina
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Li L, Zhu C, Huang H. Clinical epidemiology and outcomes of biliary tract infections caused by Klebsiella pneumoniae. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:304. [PMID: 31475174 DOI: 10.21037/atm.2019.06.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Background Biliary tract infection (BTI) is a common cause of bacteremia, and is associated with high morbidity and mortality. The clinical epidemiology and outcomes of BTI caused by Klebsiella pneumoniae (KP) have not been well investigated. Methods This was a retrospective study performed at a university teaching hospital in China from May 2012 to June 2017 that analyzed data for 119 patients with BTI caused by KP. We identified KP from bile cultures obtained before endoscopic or surgical treatment. Patients' demographic characteristics and clinical outcomes were also recorded. Results Forty-seven KP strains (39.5%) were positive for the extended spectrum beta-lactamase (ESBL) phenotype. The ESBL-positive group had a higher rate of stay in ICU [12.8% vs. 1.4% (ESBL-negative group); P=0.015] and a significantly longer hospital stay (30.79±31.512 vs. 20.06±23.945 days, respectively; P=0.037). There were no significant differences for 30-day mortality between the two groups; 112 (94.1%) patients survived and 7 (5.9%) died within 30-days of onset. Univariate analysis showed that nonsurvivors were significantly more likely to be older (66.46±22.34 vs. 46±14.84 years, respectively; P=0.001), and have hypoproteinemia (5/7, 71.4% vs. 21/112, 18.8%; P=0.006), immunosuppression (3/7, 42.9% vs. 4/112, 3.6%; P=0.004), solid tumors (5/7, 71.4% vs. 20/112, 17.9%; P=0.004), bloodstream infections (6/7, 85.7% vs. 22/112, 19.6%; P=0.001), and lower surgery rates (1/7, 14.3% vs. 66/112, 58.9%; P=0.042) compared with survivors, respectively. However, we found no significant independent risk factor for mortality. The malignant biliary obstruction group was significantly more likely to have chronic liver disease (P=0.035) than the benign biliary obstruction group, and mortality was higher for the malignant biliary obstruction group (5/25, 20% vs. 2/94, 2.1%, respectively; P=0.05). The malignant biliary group also had higher alkaline phosphatase, and direct and total bilirubin direct levels. Multivariate analysis showed that chronic liver disease was an independent risk factor in patients with malignant biliary disease [odds ratio (OR), 2.431; 95% confidence interval, 1.834-4.031; P=0.001]. Conclusions Patients with BTI caused by KP were more likely to have the ESBL phenotype, and antibiotic resistance was not associated with overall survival. Patients with malignant biliary obstruction had higher mortality, and chronic liver disease was an independent risk factor.
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Affiliation(s)
- Lanyu Li
- Department of Emergency Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Changqing Zhu
- Department of Emergency Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Huan Huang
- Department of Emergency Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
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Prospective Comparison of Bleeding Complications Between Right and Left Approaches in Percutaneous Biliary Drainage. Surg Laparosc Endosc Percutan Tech 2019; 29:7-12. [PMID: 30516719 DOI: 10.1097/sle.0000000000000609] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The present study aimed to determine whether the percentage of bleeding complications differs between the right and the left approaches in percutaneous biliary drainage (PBD) in adult patients. MATERIALS AND METHODS This was a prospective, descriptive, nonrandomized comparative and longitudinal study. We included adult patients over 18 years of age who underwent a PBD. We excluded those with a bilateral PBD for the comparative study. Usually, but not exclusively, we performed the right approach under fluoroscopic guidance and the left one under ultrasound and fluoroscopy. RESULTS Of 150 cases, 63 were performed using the right approach and 61 with the left; 26 were performed with the bilateral. The right approach faced less dilated biliary ducts and more benign diseases. We experienced 20 bleeding complications (13.33%, confidence intervals of 95%=8.3-19.8), 7 in the bilateral approach, 10 in the right approach, and 3 in the left one. The difference between the right and the left approaches was statistically significant (Fisher P=0,04). No procedures were required to obtain hemostasis, and only one patient (0.66%, confidence intervals of 95%=0.009-3.66) (in the right side) required a red blood cell transfusion. We found no related mortality. CONCLUSIONS Global bleeding complications are more likely to appear in the right approach in which less dilated biliary ducts and more benign diseases probably contributed to a higher number of needle passes, portal and hepatic vein punctures, and, therefore, to an increase in the risk of bleeding complications. The significant bleeding complication rate was low (0.66%).
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Kim IH, Choi JK, Lee DG, Lee IS, Hong TH, You YK, Chun HJ, Lee MA. Clinical significance of isolated biliary candidiasis in patients with unresectable cholangiocarcinoma. Hepatobiliary Pancreat Dis Int 2016; 15:533-539. [PMID: 27733324 DOI: 10.1016/s1499-3872(16)60109-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The frequency of isolated biliary candidiasis is increasing in cancer patients. The clinical significance of isolated biliary candidiasis remains unclear. We analyzed the risk factors of biliary candidiasis and outcomes of the patients with unresectable cholangiocarcinoma after percutaneous transhepatic biliary drainage (PTBD). METHODS Among 430 patients who underwent PTBD between January 2012 and March 2015, 121 patients had unresectable cholangiocarcinoma. Bile and blood samples were collected for consecutive fungal culture. RESULTS The study cohort included 49 women and 72 men with a median age of 71 years. Multivariate analysis showed that cancer progression (P=0.013), concurrent presence of another microorganism (P=0.010), and previous long-term (>7 days) antibiotic use (P=0.011) were potential risk factors of biliary candidiasis. Chemotherapy was not associated with overall biliary candidiasis (P=0.196), but was significantly related to repeated biliary candidiasis (P=0.011). Patients with isolated biliary candidiasis showed remarkably reduced survival compared with those without [median overall survival (OS): 32 vs 62 days, P=0.011]. Subgroup analysis was also performed. Patients with repeated candidiasis had markedly decreased survival compared with those with transient candidiasis (median OS: 30 vs 49 days, P=0.046). Biliary candidiasis was identified as a poor prognostic factor by univariate and multivariate analyses (P=0.033). Four cases of repeated candidiasis (4/19, 21%) showed Candida species in consecutive blood culture until the end of the study, but others showed no candidemia. CONCLUSIONS Isolated biliary candidiasis may be associated with poor prognosis in patients with unresectable cholangiocarcinoma. Especially, repeated biliary candidiasis may have the possibility of progression to candidemia. We suggest that biliary dilatation treatment or antifungal agents might be helpful for patients with biliary candidiasis.
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Affiliation(s)
- In-Ho Kim
- Departments of Internal Medicine, Division of Medical Oncology, and Department of Hepato-Biliary-Pancreatic Cancer Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
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Xu C, Lv PH, Huang XE, Wang SX, Sun L, Wang FA. Analysis of different ways of drainage for obstructive jaundice caused by hilar cholangiocarcinoma. Asian Pac J Cancer Prev 2015; 15:5617-20. [PMID: 25081675 DOI: 10.7314/apjcp.2014.15.14.5617] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the prognosis of different ways of drainage for patients with obstructive jaundice caused by hilar cholangiocarcinoma. MATERIALS AND METHODS During the period of January 2006- March 2012, percutaneous transhepatic catheter drainage (PTCD)/ percutaneous transhepatic biliary stenting (PTBS) were performed for 89 patients. According to percutaneous transhepatic cholangiography (PTC), external drainage was selected if the region of obstruction could not be passed by guide wire or a metallic stent was inserted if it could. External drainage was the first choice if infection was diagnosed before the procedure, and a metallic stent was inserted in one week after the infection was under control. Selection by new infections, the degree of bilirubin decrease, the change of ALT, the time of recurrence of obstruction, and the survival time of patients as the parameters was conducted to evaluate the methods of different interventional treatments regarding prognosis of patients with hilar obstruction caused by hilar cholangiocarcinoma. RESULTS PTCD was conducted in 6 patients and PTBS in 7 (p<0.05). Reduction of bilirubin levels and ALT levels was obvious after the procedures (p<0.05). The average survival time with PTCD was 161 days and with PTBS was 243 days (p<0.05). CONCLUSIONS With both drainage procedures for obstructive jaundice caused by hilar cholangiocarcinoma improvement in liver function was obvious. PTBS was found to be better than PTCD for prolonging the patient survival.
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Affiliation(s)
- Chuan Xu
- Department of Interventional Radiology, Subei People's Hospital of Jiangsu Province, Clinical Hospital of Yangzhou University, Yangzhou, China E-mail :
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Xu C, Huang XE, Wang SX, Lv PH, Sun L, Wang FA. Comparison of Infection between Internal-External and External Percutaneous Transhepatic Biliary Drainage in Treating Patients with Malignant Obstructive Jaundice. Asian Pac J Cancer Prev 2015; 16:2543-6. [DOI: 10.7314/apjcp.2015.16.6.2543] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Han YZ, Zhu XD, Shang GC, Zheng Y, Chen WG. Clinical effects of endoscopic sphincterotomy and papillary balloon dilation for treatment of obstructive jaundice. Shijie Huaren Xiaohua Zazhi 2015; 23:984-989. [DOI: 10.11569/wcjd.v23.i6.984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the clinical effects of endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD), alone or in combination, in the management of obstructive jaundice.
METHODS: A retrospective analysis was performed of the clinical data of 97 patients with obstructive jaundice treated at the First Affiliated Hospital of Shihezi University from January 2013 to August 2014.
RESULTS: The 97 patients were divided into three groups: an EST group (n = 55), an EPBD group (n = 8) and a small EST plus balloon dilatation (sEST + EPBD) group (n = 34). The clinical symptoms such as abdominal pain and jaundice were relieved obviously after these treatments. The success rate of first stone removal was significantly higher in the sEST + EPBD group than in the other two groups (P < 0.05). For choledocholithiasis with duodenal diverticula, the sEST + EPBD group also had a significantly higher success rate of stone removal than the EST group (P < 0.05). The EST group had a significantly lower rate of hyperamylasemia compared with the EPBD group (P < 0.05).
CONCLUSION: EST, EPBD, and sEST + EPBD are all effective for palliative treatment of biliary obstruction. sEST + EPBD is associated with a higher rate of stone removal and a lower incidence rate of postoperative complications, especially for patients with biliary anatomical changes such as duodenal diverticulum.
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Xu C, Lv PH, Huang XE, Sun L, Wang SX, Wang FA. Internal-external percutaneous transhepatic biliary drainage for patients with malignant obstructive jaundice. Asian Pac J Cancer Prev 2014; 15:9391-4. [PMID: 25422230 DOI: 10.7314/apjcp.2014.15.21.9391] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the effect of internal-external percutaneous transhepatic biliary drainage (IEPTBD) for patients with malignant obstructive jaundice. METHODS During the period of January 2008 and July 2013, internal-external drainage was performed in 42 patients with malignant obstructive jaundice. During the procedure, if the guide wire could pass through the occlusion and into the duodenum, IEPTBD was performed. External drainage biliary catheter was placed if the occlusion was not crossed. Newly onset of infection, degree of bilirubin decrease and the survival time of patients were selected as parameters to evaluate the effect of IEPTBD. RESULTS Twenty newly onset of infection were recorded after procedure and new infectious rate was 47.6%. Sixteen patients with infection (3 before, 13 after drainage) were uncontrolled after procedure, 12 of them (3 before, 9 after drainage) died within 1 month. The mean TBIL levels declined from 299.53 umol/L before drainage to 257.62 umol/L after drainage, while uninfected group decline from 274.86 umol/L to 132.34 umol/Lp (P < 0.5). The median survival time for uninfected group was 107 days, and for infection group was 43 days (P < 0.05). CONCLUSIONS The IEPTBD drainage may increase the chance of biliary infection, reduce bile drainage efficiency and decrease the long-term prognosis, and the external drainage is a better choice for patients with malignant obstructive jaundice need to biliary drainage.
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Affiliation(s)
- Chuan Xu
- Department of Interventional Radiology, Subei People's Hospital of Jiangsu Province, Clinical Hospital of Yangzhou University, Yangzhou, China E-mail :
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Xu C, Huang XE, Wang SX, Lv PH, Sun L, Wang FA, Wang LF. Drainage alone or combined with anti-tumor therapy for treatment of obstructive jaundice caused by recurrence and metastasis after primary tumor resection. Asian Pac J Cancer Prev 2014; 15:2681-4. [PMID: 24761884 DOI: 10.7314/apjcp.2014.15.6.2681] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AIM To compare drainage alone or combined with anti-tumor therapy for treatment of obstructive jaundice caused by recurrence and metastasis after primary tumor resection. MATERIALS AND METHODS We collect 42 patients with obstructive jaundice caused by recurrence and metastasis after tumor resection from January 2008 - August 2012, for which percutaneous transhepatic catheter drainage (pTCD)/ percutaneous transhepatic biliary stenting (pTBS) were performed. In 25 patients drainage was combined with anti-tumor treatment, antineoplastic therapy including intra/postprodure local treatment and postoperative systemic chemotherapy, the other 17 undergoing drainage only. We assessed the two kinds of treatment with regard to patient prognosis. RESULTS Both treatments demonstrated good effects in reducing bilirubin levels in the short term and promoting liver function. The time to reobstruction was 125 days in the combined group and 89 days in the drainage only group; the mean survival times were 185 and 128 days, the differences being significant. CONCLUSIONS Interventional drainage in the treatment of the obstructive jaundice caused by recurrence and metastasis after tumor resection can decrease bilirubin level quickly in a short term and promote the liver function recovery. Combined treatment prolongs the survival time and period before reobstruction as compared to drainage only.
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Affiliation(s)
- Chuan Xu
- Department of Interventional Radiology, Subei People Hospital of Jiangsu Province, Clinical Hospital of Yangzhou University, Yangzhou, China E-mail :
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Malignant biliary obstructions: can we predict immediate postprocedural cholangitis after percutaneous biliary drainage? Support Care Cancer 2013; 21:2321-6. [DOI: 10.1007/s00520-013-1796-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 03/14/2013] [Indexed: 02/03/2023]
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Bile culture and susceptibility testing of malignant biliary obstruction via PTBD. Cardiovasc Intervent Radiol 2011; 35:1136-44. [PMID: 21904809 DOI: 10.1007/s00270-011-0263-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 08/11/2011] [Indexed: 01/23/2023]
Abstract
PURPOSE To assess the information obtained by bile culture and susceptibility testing for malignant biliary obstruction by a retrospective one-center study. METHODS A total of 694 patients with malignant biliary obstruction received percutaneous transhepatic biliary drainage during the period July 2003 to September 2010, and subsequently, bile specimens were collected during the procedure. Among the 694 patients, 485 were men and 209 were women, ranging in age from 38 to 78 years (mean age 62 years). RESULTS A total of 42.9% patients had a positive bile culture (298 of 694). Further, 57 species of microorganisms and 342 strains were identified; gram-positive bacteria accounted for 50.9% (174 of 342) and gram-negative bacteria accounted for 41.5% (142 of 342) of these strains. No anaerobes were obtained by culture during this study. The most common microorganisms were Enterococcus faecalis (41 of 342, 11.9%), Escherichia coli (34 of 342, 9.9%), Klebsiella pneumoniae (28 of 342, 8.2%), Staphylococcus epidermidis (19 of 342, 5.5%), Enterococcus (18 of 342, 5.3%), and Enterobacter cloacae (16 of 342, 4.7%). The percentage of β-lactamase-producing gram-positive bacteria was 27.6% (48 of 174), and the percentage of gram-negative bacteria was 19.7% (28 of 142). The percentage of enzyme-producing Escherichia coli was 61.7% (21 of 34). CONCLUSION The bile cultures in malignant biliary obstruction are different from those in the Tokyo Guidelines and other benign biliary obstruction researches, which indicates that a different antibacterial therapy should be applied. Thus, knowledge of the antimicrobial susceptibility data could aid in the better use of antibiotics for the empirical therapy of biliary infection combined with malignant biliary obstruction.
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