Improvement of percutaneous transhepatic biliary internal-external drainage and its initial experience in patients with malignant obstruction of the upper biliary tree.

BACKGROUND/AIMS: To evaluate the feasibility and clinical results of modified percutaneous transhepatic biliary internal-external drainage (PTBIED) vs. conventional PTBIED in patients with malignant biliary obstruction.

METHODOLOGY

Conventional PTBIED was modified by applying side-holes to an 8.5Fr external biliary drainage catheter. Eligible patients were randomly assigned 1:1 by the doctors to receive modified PTBIED (group A) or conventional PTBIED (group B). Technical success rate, complications, hepatic function and white cell count were recorded pre- and post-procedure. All patients were followed-up until death.

RESULTS

Twenty-two patients were assigned in group A and 21 patients were involved in group B. Successful drainage was all achieved in both groups. Biliary tract infections were significantly reduced in group A (1/22) compared to group B (7/21, p<0.05). The leukocyte count fell slightly in group A post-procedure, while it rose in group B (group A: 8.45±3.22-109/L to 7.53±2.46-109/L; group B: 7.92±3.08-109/L to 10.52±5.09-109/L). Both procedures had similar effects in the recovery of hepatic function, median survival time and alleviating clinical symptoms (such as pruritis and abdominal pain).

CONCLUSIONS

Modified PTBIED can reduce the complications resulting from retrograde reflux of duodenal contents. Improved PTBIED should be used for patients with inoperable high malignant biliary obstruction.