Management and outcomes of patients with obstructive jaundice from pancreatobiliary diseases in Rwanda.

BACKGROUND

Obstructive jaundice from pancreatobiliary diseases represents a significant global health challenge, particularly in resource-limited settings like Rwanda. While endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) are now available at tertiary centers in Kigali, there is limited local clinical data on the management and outcomes of these conditions. This study aims to assess the patterns, therapeutic approaches, and outcomes of obstructive jaundice in the Rwandan healthcare context.

METHODS

A cross-sectional study was conducted across three tertiary hospitals (KFH, RMH, and CHUK) in Rwanda from July 2023 to June 2024. Using Fischer's formula, 158 patients with obstructive jaundice from pancreatobiliary diseases were enrolled. Data collection involved chart reviews at admission, procedure, post-procedure, discharge, and 30-day follow-up. Analysis was performed using Stata version 13, with descriptive statistics, bivariate analysis using chi-square, and multivariate analyses examining predictors of 30-days mortality among the participants at 95% confidence interval and p value < 0.05 considered statistically significant. Multicollinearity assessment was also performed considering the target variance inflation factor (VIF) < 5.

RESULTS

In this study of 158 patients with obstructive jaundice in Rwanda, ERCP was the predominant intervention (77.54%), followed by PTBD (17.39%) and surgical procedures (5.07%). The overall procedures technical success rate was 82.61%; with PTBD success rate of 91.67%, surgical procedures showed higher success rate 100%, while ERCP had a success rate of 79.44%. Post-procedure complications occurred in 16.67% of cases, including pancreatitis (5%), bleeding (3.62%), and mortality (4.34%). The 30-day survival rate was 92.41%, demonstrating generally favorable outcomes in managing pancreaticobiliary diseases. The multivariate analysis showed that weight loss increased mortality risk (aOR = 10.647, 95% CI: 1.190-95.256, p = 0.034), while the absence of CBD stones was protective (aOR = 0.087, 95% CI: 0.008-0.888, p = 0.039). Having a procedure performed significantly reduced mortality odds (aOR = 0.025, 95% CI: 0.006-0.117, p < 0.001). ICU/HDU admission was associated with higher mortality risk in 30 days (aOR = 13.051, 95% CI: 2.010-84.731, p = 0.007).

CONCLUSION

This study from Rwanda provides crucial insights into the management and outcomes of obstructive jaundice from pancreatobiliary diseases. PTBD was demonstrated high success. While post-procedure complications occurred, the 30-day survival rate was favorable. Weight loss and ICU admission were associated with increased mortality, while procedural interventions showed protective effects, highlighting the importance of timely management.