Posters
« Back
Percutaneous Trans-hepatic Biliary Drainage for Malignant Biliary Stricture: Outcomes from University Hospital Coventry Warwickshire from 2015-2020
EP34339
Poster Title: Percutaneous Trans-hepatic Biliary Drainage for Malignant Biliary Stricture: Outcomes from University Hospital Coventry Warwickshire from 2015-2020
Submitted on 30 Oct 2020
Author(s): Dr Deevia Hanji, Dr Sharmila Sothi, Dr Martin Scott-Brown, Dr Manpreet Dhillon, Dr Neil Gupta, Dr Abbas Hasan, Dr Jessica Gilbert, Dr James Harding
Affiliations: University Hospital Coventry & Warwickshire
This poster was presented at BIR Annual Congress 2020
Poster Views: 129
View poster »


Poster Information
Abstract: Inoperable malignant biliary obstruction confers a poor prognosis. Percutaneous trans-hepatic biliary drainage (PTBD) aims to offer palliation of symptoms or enable SACT (systemic anti-cancer treatment) but is associated with significant morbidity and mortality.

Methods: Retrospective study of 152 patients (ages 37-95) undergoing first PTBD for inoperable malignant stricture at University Hospital Coventry & Warwickshire from 2015-2020, analysed via hospital database search.

Results:
Median survival: 88 days (range 2-976), Median in-hospital stay: 11 days (range 1-57).
Mortality: In hospital: 21%, 7-day: 5.9%, 30-day: 30% and 90-day: 49%.

30-day readmission rate was 16.4% and re-admission due to infection 6.6%.

12.5% developed post procedure sepsis - 37% of which had a positive bacteraemia (60% with gram negative pathogens) and 10% isolated pathogens from the biliary fluid. Patients with sepsis averaged a 14 day stay (vs 10 days) and had reduced median survival (62 vs 88 days)

Factors associated with reduced median survival (days):
Age >70years (70 vs 117 days in ages 0-69)
Previous failed ERCP (58 vs 92 days if no ERCP)
Previous SACT (70 vs 89 days without SACT)
Raised Bilirubin >200umol/L (50 vs 123 days if bilirubin <200umol/L)
Low Albumin <35g/L (62 vs 119 days if Albumin >35g/L)


Conclusion:
Infection, with a high yield of microbes isolated in blood and biliary fluid is common and longer peri-operative courses of antibiotics and routine biliary fluid testing should be considered.

Given the high mortality rates, careful patient selection considering the factors above – including identification of the intent (palliation/ to enable SACT), remains paramount.
Summary: Inoperable malignant biliary obstruction confers a poor prognosis. Percutaneous trans-hepatic biliary drainage (PTBD) aims to offer palliation of symptoms or enable SACT (systemic anti-cancer treatment) but is associated with significant morbidity and mortality. We reviewed the outcomes of 152 patients undergoing the procedure at University Hospital Coventry & Warwickshire to identify factors associated with better prognosis. References: 1. Chu D, Adler DG. Malignant biliary tract obstruction: evaluation and therapy. J Natl Compr Canc Netw 2010;8:1033–44.

2. Case courtesy of Dr Nitin Garg, Radiopaedia.org, rID: 27563

3 J, Mytton J, Evison F, et al. The outcomes
of biliary drainage by percutaneous transhepatic cholangiography for the palliation of malignant biliary obstruction in England between 2001 and 2014: a retrospective cohort study. BMJ Open 2020;10:e033576. doi:10.1136/ bmjopen-2019-033576

4. Early Infectious Complications of Percutaneous Metallic Stent Insertion for Malignant Biliary Obstruction. Yu Li Sol, Chang Won Kim, Ung Bae Jeon, Nam Kyung Lee, Suk Kim, Dae Hwan Kang, and Gwang Ha Kim, American Journal of Roentgenology 2010 194:1, 261-265

5. Saluja SS, Gulati M, Garg PK, et al. Endoscopic or percutaneous biliary drainage for gallbladder cancer: a randomized trial and quality of life assessment. Clin Gastroenterol Hepatol 2008;6:944–50.

6. Saad WEA, Wallace MJ,
Report abuse »
Questions
Ask the author a question about this poster.
Ask a Question »

Creative Commons

Related Posters


133:Geographic Tongue and Oral Dysesthesia Associated With Sunitinib: A Case Report[AAOM2021}
Alphonse Jimmy, Ruchi Trambadia, Caroline Hanna, Chizobam Idahosa, BDS, DDS, MS

111:Fate of Epithelial Palatal Seam With Smad2 Over-expression[AAOM2021]
Dr. Husein Al-Omer¹ʼ³, Dr. Gihan E-H Gawish²ʼ³

102:From a Non-Specific Inflammatory-Like Gingival Lesion to a Rapidly Progressing Oral Squamous Cell Carcinoma: A Case of Deceptive Presentation of Oral Cancer[AAOM2021]
Ayelet Zlotogorski Hurvitz1,2, Marilena Vered1,3, Alex Dobriyan4, Ran Yahalom4, Ilana Kaplan1,5

127: Recurrent Form of Oral Candidiasis in Liver Transplant Recipient
Marketa Janovska, Stepan Podzimek

123: Oral Mucosal Lesions In Association With Goodpasture´s Syndrome
Marketa Janovska, Stepan Podzimek, Zdenek Hruby