Percutaneous Biliary Drainage

Percutaneous Biliary Drainage

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Over the past few decades, biliary interventions have evolved a great deal. Opacification of the biliary system was first reported in 1921 with direct puncture of the gallbladder. Subsequent reports described direct percutaneous biliary puncture. The technique was revolutionized in 1960s with the introduction of fine-gauge (22- to 23-gauge) needles.

During the 1970s, percutaneous biliary drainage (PBD) for obstructive jaundice and percutaneous treatment of stone disease was introduced. [1, 2]  Percutaneous cholecystostomy was first described in the 1980s. With the advent of metallic and plastic internal stents, further applications in the treatment of biliary diseases were developed.

Current percutaneous biliary interventions include percutaneous transhepatic cholangiography (PTC) and biliary drainage to manage benign [3]  and malignant obstruction and percutaneous cholecystostomy. Percutaneous treatment of biliary stone disease with or without choledochoscopy is still performed in selected cases. Other applications include cholangioplasty for biliary strictures, biopsy of the biliary duct, and management of complications from laparoscopic cholecystectomy and liver transplantation.

This article outlines the procedure for percutaneous biliary drainage. [4]  For descriptions of other biliary interventions, see Percutaneous CholecystostomyPercutaneous Transcutaneous Cholangiography, and Biliary Stenting.

In many cases, PTC is followed by the placement of percutaneous biliary catheters for drainage. PBD is needed in many patients. For example, it may be helpful in relieving obstructive symptoms, especially those due to unresectable malignant tumors (see the image below), though its value in the setting of malignant biliary obstruction has been questioned by some. [5] PBD may also be helpful in treating those with various types of benign strictures (including postoperative strictures), primary sclerosing cholangitis and liver transplants. [6]

Other indications include cholangitis secondary to biliary obstruction, diversion for bile leaks while the patient is awaiting surgery, and transhepatic brachytherapy for cholangiocarcinoma.

Nowadays, endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay of therapy for the above conditions, with PBD being reserved for conditions in which ERCP fails or is not available.

Contraindications for PBD include the following [7] :

Fang Y, Gurusamy KS, Wang Q, Davidson BR, Lin H, Xie X, et al. Meta-analysis of randomized clinical trials on safety and efficacy of biliary drainage before surgery for obstructive jaundice. Br J Surg. 2013 Nov. 100 (12):1589-96. [Medline].

Mueller PR, Ferrucci JT Jr, Teplick SK, vanSonnenberg E, Haskin PH, Butch RJ, et al. Biliary stent endoprosthesis: analysis of complications in 113 patients. Radiology. 1985 Sep. 156 (3):637-9. [Medline].

Köcher M, Cerná M, Havlík R, Král V, Gryga A, Duda M. Percutaneous treatment of benign bile duct strictures. Eur J Radiol. 2007 May. 62 (2):170-4. [Medline].

Kedia P, Gaidhane M, Kahaleh M. Endoscopic guided biliary drainage: how can we achieve efficient biliary drainage?. Clin Endosc. 2013 Sep. 46 (5):543-51. [Medline]. [Full Text].

Niemelä J, Kallio R, Ohtonen P, Perälä J, Saarnio J, Syrjälä H. Is Palliative Percutaneous Drainage for Malignant Biliary Obstruction Useful?. World J Surg. 2018 Sep. 42 (9):2980-2986. [Medline].

Artifon EL, Aparicio D, Paione JB, Lo SK, Bordini A, Rabello C, et al. Biliary drainage in patients with unresectable, malignant obstruction where ERCP fails: endoscopic ultrasonography-guided choledochoduodenostomy versus percutaneous drainage. J Clin Gastroenterol. 2012 Oct. 46 (9):768-74. [Medline].

Ring EJ, Kerlan RK Jr. Interventional biliary radiology. AJR Am J Roentgenol. 1984 Jan. 142 (1):31-4. [Medline].

Iwashita T, Doi S, Yasuda I. Endoscopic ultrasound-guided biliary drainage: a review. Clin J Gastroenterol. 2014 Apr. 7 (2):94-102. [Medline]. [Full Text].

Sharaiha RZ, Kumta NA, Desai AP, DeFilippis EM, Gabr M, Sarkisian AM, et al. Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage: predictors of successful outcome in patients who fail endoscopic retrograde cholangiopancreatography. Surg Endosc. 2016 Dec. 30 (12):5500-5505. [Medline].

Quencer KB, Tadros AS, Marashi KB, Cizman Z, Reiner E, O’Hara R, et al. Bleeding after Percutaneous Transhepatic Biliary Drainage: Incidence, Causes and Treatments. J Clin Med. 2018 May 1. 7 (5):[Medline]. [Full Text].

Wagner A, Mayr C, Kiesslich T, Berr F, Friesenbichler P, Wolkersdörfer GW. Reduced complication rates of percutaneous transhepatic biliary drainage with ultrasound guidance. J Clin Ultrasound. 2017 Sep. 45 (7):400-407. [Medline].

Nennstiel S, Treiber M, Faber A, Haller B, von Delius S, Schmid RM, et al. Comparison of Ultrasound and Fluoroscopically Guided Percutaneous Transhepatic Biliary Drainage. Dig Dis. 2018 Sep 25. 1-10. [Medline].

Altaf Dawood, MBBS, MD Chief Medical Resident and Clinical Instructor, Department of Internal Medicine, University of Nevada School of Medicine

Altaf Dawood, MBBS, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Vijay Jayaraman, MD Assistant Professor of Medicine, Division of Gastroenterology, University of Nevada School of Medicine

Vijay Jayaraman, MD is a member of the following medical societies: American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, Medical Society of the State of New York, New York Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Douglas M Coldwell, MD, PhD Professor of Radiology, Director, Division of Vascular and Interventional Radiology, University of Louisville School of Medicine

Douglas M Coldwell, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Heart Association, SWOG, Special Operations Medical Association, Society of Interventional Radiology, American Physical Society, American College of Radiology, American Roentgen Ray Society

Disclosure: Received consulting fee from Sirtex, Inc. for speaking and teaching; Received honoraria from DFINE, Inc. for consulting.

Kyung J Cho, MD, FACR, FSIR William Martel Emeritus Professor of Radiology (Interventional Radiology), Frankel Cardiovascular Center, University of Michigan Health System

Kyung J Cho, MD, FACR, FSIR is a member of the following medical societies: American College of Radiology, American Heart Association, American Medical Association, American Roentgen Ray Society, Association of University Radiologists, Radiological Society of North America

Disclosure: Nothing to disclose.

Gary P Siskin, MD Professor and Chairman, Department of Radiology, Albany Medical College

Gary P Siskin, MD is a member of the following medical societies: American College of Radiology, Society of Interventional Radiology, Cardiovascular and Interventional Radiological Society of Europe, Radiological Society of North America

Disclosure: Nothing to disclose.

Author: Altaf Dawood, MBBS, MD, Chief Medical Resident and Clinical Instructor, Department of Internal Medicine, University of Nevada School of Medicine.

Altaf Dawood is a member of the following medical societies: American College of Physicians.

Coauthor(s): Vijay Jayaraman, MD, Assistant Professor of Medicine, Division of Gastroenterology, University of Nevada School of Medicine.

Disclosure: Nothing to disclose.

Percutaneous Biliary Drainage

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