INTERNAL-EXTERNAL VS EXTERNAL PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE IN MANAGEMENT OF MALIGNANT INOPERABLE BILIARY OBSTRUCTION- A RETROSPECTIVE STUDY

Abstract

Background: Cases diagnosed with malignant biliary obstruction are often advanced and inoperable at the time of presentation and therefore carry a very poor prognosis. Less is known about the role of percutaneous transhepatic biliary drainage (PTBD) in management of this patient population. In available literature there is inadequate data regarding comparative analysis of internal-external drainage (IED) and external drainage (ED)

Purpose: To portray efficacy of PTBD in management of malignant biliary obstruction and compare between ED alone and combined IED regarding outcome.

 Methods: Twenty cases of biliary drainage (12 cases of ED and 8 cases of IED) done at our institution were retrospectively reviewed and reassessed over a period of 6 months between February 2014 and July 2014 by clinical and biochemical evaluation on day 7,14 and 28 after procedure.

Results: Maximum number of patients (9;45%) were in their 6^th  decade. Out of 20 patients 14 were female (70%),6 were male(30%).According to etiology gall bladder carcinoma which was diagnosed in 6 cases(30%) was commonest of all. There were 1 failed attempt (5%), 3 catheter expulsions (15%) following ED and 1 procedure related biliary sepsis (5%) after IED. On follow up serum biochemical markers came down to desired level (2mg/dl) approximately within a week in case of IED and two weeks after ED. Clinical improvement was also remarkably better in IED group. Chemotherapy was initiated in 5 patients (25%) following IED and 3 patients (15%) after ED after 1 week.

Conclusion: IED is much better than ED alone in terms of more rapid clinical and biochemical improvement, catheter positional stability, easy access to future stenting and early initiation of chemotherapy.

Keywords: biliary obstruction , external drainage, gall bladder carcinoma, internal-external drainage