Learning objectives
Complications of percutaneous biliary interventions are known to occur.
Most of the complications are self-limiting in nature though major complications resulting in increased level of patient care,
prolonged hospital-stay as well as patient death do occur infrequently.
This study was undertaken for two objectives.
* To illustrate the vascular complications of percutaneous biliary drainage procedures as important causes of mortality and morbidity.
* To understand the technical and patient related factors which contribute to such complications.
Background
Percutaneous transhepatic biliary drainage (PTBD) continues to be performed widely despite advances in the techniques of endoscopically guided biliary procedures.
It is an effective method for decompressing biliary obstruction or diverting bile in leakage after ERCP has failed or not possible due to technical reasons [1].
Though percutaneous biliary decompression is associated with a low complication rate,
major complications can still occur.
Most common complications associated with PTBD are hemobilia,
fever and catheter dislodgement [2].
Major complications like large local infection,
sepsis and vascular complications...
Imaging findings OR Procedure details
Between 1st June and 30th November 2012,
111 consecutive percutaneous biliary interventions in 68 patients were performed.
Multiple procedures (67) accounted for 60% of all interventions compared to 40% single procedures (44).
Peripancreatic cancers and cholangiocarcinomas were the leading causes of biliary obstruction requiring biliary interventions.
All procedures were performed with therapeutic intentions.
No stand alone diagnostic PTC was performed.
Non-dilated or minimally dilated ducts were targeted by a 21G fine needle whereas obviously dilated bile ducts were punctured by an 18G needle.
Ultrasound was...
Conclusion
Complications of percutaneous biliary interventions varies with patient status,
diagnosis and degree of biliary dilatation [5] with low complication rates,
both major and minor,
with the use of a 21G needle [6].
In this series all fatalities directly attributable to major vascular complications occurred after cannulation by a thin needle (21G) in non-dilated/ mildly dilated biliary tract and/or repeated or vigorous manipulation with equipment/catheters.
Patient status however had an impact on choice of therapy after development of complications.
Overall rate of major complications in this...
References
References:
George E.
Lynskey,
Filip Banovac,
Thomas Chang.
Vascular complications associated with percutaneous biliary drainage: A report of three cases.
Semin Intervent Radiol 2007; 24: 316-319
Burke DR,
Lewis CA,
Cardella JF et al.
Quality improvement guidelines for percutaneous transhepatic cholangiography and biliary drainage.
J Vasc Interv Radiol 2003; 14: S243-S246
Mueller PR,
vanSonnenberg E,
Ferricci JT Jr.
Percutaneous biliary drainage: Technical and catheter related problems in 200 procedures.
AJR 1982; 138: 17-23
Born P,
Rosch T,
Triptrap A,
et al.
Long term results of...