Percutaneous biliary drainage for obstructive jaundice in patients with inoperable, malignant biliary obstruction

AIM OF THE STUDY: Most of the malignancies leading to obstructive jaundice are diagnosed too late when they are already advanced and inoperable, with palliation being the only treatment option left. Due to progressing hyperbilirubinaemia with its consequent adverse effects, biliary drainage must be...

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Autores principales: Zerem, Enver, Imširović, Bilal, Kunosić, Suad, Zerem, Dina, Zerem, Omar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Termedia Publishing House 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8984794/
https://www.ncbi.nlm.nih.gov/pubmed/35415254
http://dx.doi.org/10.5114/ceh.2022.114190
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author Zerem, Enver
Imširović, Bilal
Kunosić, Suad
Zerem, Dina
Zerem, Omar
author_facet Zerem, Enver
Imširović, Bilal
Kunosić, Suad
Zerem, Dina
Zerem, Omar
author_sort Zerem, Enver
collection PubMed
description AIM OF THE STUDY: Most of the malignancies leading to obstructive jaundice are diagnosed too late when they are already advanced and inoperable, with palliation being the only treatment option left. Due to progressing hyperbilirubinaemia with its consequent adverse effects, biliary drainage must be established even in advanced malignancies. This study aims to investigate and analyse factors that affect clinical outcomes of percutaneous trans-hepatic biliary drainage (PTBD) in patients with obstructive jaundice due to advanced inoperable malignancy, and identify potential predictors of patient survival. Study design: Observational retrospective cohort study. MATERIAL AND METHODS: Baseline variables and clinical outcomes were evaluated in 108 consecutive patients treated with PTBD. The study’s primary endpoints were significant bilirubin level decrease and survival rates. Secondary endpoints included periprocedural major and minor complication rates and catheter primary and secondary patency rates. RESULTS: PTBD was technically successful and bile ducts were successfully drained in all 108 patients. Median serum bilirubin level, which was 282 (171-376) µmol/l before drainage, decreased significantly, to 80 (56-144) µmol/l, 15 days after stent placement (p < 0.001). Patient survival ranged from 3 to 597 days and the overall (median) survival time following PTBD was 168 days (90-302). The 1, 3, 6, 12 and 18-month survival rates were 96.3%, 75.9%, 48.1%, 8.3% and 1.9%, respectively. Multivariate analysis revealed that liver metastases and alkaline phosphatase were significantly associated with mortality. The overall complication rate was 9.3%. CONCLUSIONS: PTBD is a safe and effective method to relieve jaundice caused by advanced inoperable malignant disease. Careful patient selection is necessary when introducing PTBD in order to avoid invasive procedures in patients with a poor prognosis.
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spelling pubmed-89847942022-04-11 Percutaneous biliary drainage for obstructive jaundice in patients with inoperable, malignant biliary obstruction Zerem, Enver Imširović, Bilal Kunosić, Suad Zerem, Dina Zerem, Omar Clin Exp Hepatol Original Paper AIM OF THE STUDY: Most of the malignancies leading to obstructive jaundice are diagnosed too late when they are already advanced and inoperable, with palliation being the only treatment option left. Due to progressing hyperbilirubinaemia with its consequent adverse effects, biliary drainage must be established even in advanced malignancies. This study aims to investigate and analyse factors that affect clinical outcomes of percutaneous trans-hepatic biliary drainage (PTBD) in patients with obstructive jaundice due to advanced inoperable malignancy, and identify potential predictors of patient survival. Study design: Observational retrospective cohort study. MATERIAL AND METHODS: Baseline variables and clinical outcomes were evaluated in 108 consecutive patients treated with PTBD. The study’s primary endpoints were significant bilirubin level decrease and survival rates. Secondary endpoints included periprocedural major and minor complication rates and catheter primary and secondary patency rates. RESULTS: PTBD was technically successful and bile ducts were successfully drained in all 108 patients. Median serum bilirubin level, which was 282 (171-376) µmol/l before drainage, decreased significantly, to 80 (56-144) µmol/l, 15 days after stent placement (p < 0.001). Patient survival ranged from 3 to 597 days and the overall (median) survival time following PTBD was 168 days (90-302). The 1, 3, 6, 12 and 18-month survival rates were 96.3%, 75.9%, 48.1%, 8.3% and 1.9%, respectively. Multivariate analysis revealed that liver metastases and alkaline phosphatase were significantly associated with mortality. The overall complication rate was 9.3%. CONCLUSIONS: PTBD is a safe and effective method to relieve jaundice caused by advanced inoperable malignant disease. Careful patient selection is necessary when introducing PTBD in order to avoid invasive procedures in patients with a poor prognosis. Termedia Publishing House 2022-03-23 2022-03 /pmc/articles/PMC8984794/ /pubmed/35415254 http://dx.doi.org/10.5114/ceh.2022.114190 Text en Copyright © 2022 Clinical and Experimental Hepatology https://creativecommons.org/licenses/by-nc-sa/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/ (https://creativecommons.org/licenses/by-nc-sa/4.0/) )
spellingShingle Original Paper
Zerem, Enver
Imširović, Bilal
Kunosić, Suad
Zerem, Dina
Zerem, Omar
Percutaneous biliary drainage for obstructive jaundice in patients with inoperable, malignant biliary obstruction
title Percutaneous biliary drainage for obstructive jaundice in patients with inoperable, malignant biliary obstruction
title_full Percutaneous biliary drainage for obstructive jaundice in patients with inoperable, malignant biliary obstruction
title_fullStr Percutaneous biliary drainage for obstructive jaundice in patients with inoperable, malignant biliary obstruction
title_full_unstemmed Percutaneous biliary drainage for obstructive jaundice in patients with inoperable, malignant biliary obstruction
title_short Percutaneous biliary drainage for obstructive jaundice in patients with inoperable, malignant biliary obstruction
title_sort percutaneous biliary drainage for obstructive jaundice in patients with inoperable, malignant biliary obstruction
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8984794/
https://www.ncbi.nlm.nih.gov/pubmed/35415254
http://dx.doi.org/10.5114/ceh.2022.114190
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