Feasibility and safety of bedside percutaneous biliary drainage in patients with severe cholangitis
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HEPATOBILIARY
Feasibility and safety of bedside percutaneous biliary drainage in patients with severe cholangitis Pankaj Gupta1 · Muniraju Maralakunte1 · Naveen Kalra1 · Jayanta Samanta2 · Vishal Sharma2 · Harshal Mandavdhare2 · Usha Dutta2 · Rakesh Kochhar2 · Manavjit Singh Sandhu1 Received: 27 August 2020 / Revised: 3 October 2020 / Accepted: 10 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To evaluate the safety and feasibility of bedside percutaneous transhepatic biliary drainage (PTBD) as a salvage procedure in patients with severe cholangitis in the intensive care unit (ICU). Methods This retrospective study evaluated records of consecutive patients with severe cholangitis who were admitted in the ICU. Bedside PTBD was performed using ultrasound guidance. The level and cause of biliary obstruction were recorded. The technical success of the procedure and complications were recorded. Results Ten patients (six males, mean age 53.8 years) underwent bedside PTBD. Six patients had distal common bile duct blockade [periampullary carcinoma (n = 2), carcinoma pancreas (n = 2), choledocholithiasis (n = 1), and benign stricture (n = 1)]. Four patients had malignant hilar stricture [cholangiocarcinoma (n = 3) and carcinoma gallbladder (n = 1)]. Technical success was achieved in all. One patient underwent bilateral PTBD. Left and right PTBD were performed in 5 and 4 patients, respectively. There were no major complications. Transient hemobilia occurred in two patients. Conclusion Bedside PTBD is safe and technically feasible. Prospective studies are required to establish this procedure into routine clinical practice. Keywords Biliary drainage · Percutaneous · Intensive care unit
Introduction The advent of advanced endoscopic techniques has reduced the utilization of percutaneous transhepatic biliary drainage (PTBD). Yet, there is an essence and scope for PTBD in the setting of hilar strictures, failed endoscopic retrograde cholangiopancreatography (ERCP), or altered anatomy after the entero-biliary surgical procedures [1, 2]. The most crucial indication where PTBD might be a life-saving procedure is severe cholangitis [3]. Besides, the medical measures, the essential component of management is the relief of biliary obstruction. In patients with severe cholangitis, intensive care unit (ICU) management may be necessary. Many patients with severe cholangitis may be on mechanical * Pankaj Gupta [email protected] 1
Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India
Department of Gastroenterology, PGIMER, Chandigarh, India
2
ventilation. Biliary drainage in this group of patients poses a challenge. Though bedside ERCP has been reported, the facility and expertise are not available in most centers. Shifting these patients to the ERCP suite may pose a risk. These factors cause a delay in biliary drainage and worsening of the sepsis. PTBD is an effective minimally invasive interventional radiology procedure for draining the biliary sy
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