SUPERIORITY OF INTERNAL EXTERNAL DRAINAGE OVER EXTERNAL DRAINAGE IN PTBD IN PALLIATIVE BILIARY DECOMPRESSION: OUR EXPERIENCE IN A TERTIARY CARE HOSPITAL

Debashis Dakshit; Aprateem Mukherjee

SUPERIORITY OF INTERNAL EXTERNAL DRAINAGE OVER EXTERNAL DRAINAGE IN PTBD IN PALLIATIVE BILIARY DECOMPRESSION: OUR EXPERIENCE IN A TERTIARY CARE HOSPITAL

Debashis Dakshit, Aprateem Mukherjee

Abstract

Background

There is a high burden of patients with malignant biliary obstructions presenting to our institute, PTBD has become the only means of palliation as the cases most often present beyond the stage of any curative treatment. Internal External Drainage (IED) being a comparatively newer technique to External Drainage (ED), there is little data studying the two methods in our patient population.

Objectives

To show the techniques of PTBD, efficacy, complications and their management. To compare the two methods IED and ED regarding their efficacy, drawbacks, and complication rates.

Methods

A prospective study was done with 50 patients between September 2016 and August 2017. Following procedure, patients were followed up one week, two weeks and four weeks with clinical examination and biochemical evaluation.

Results

Out of 50 patients, 34 cases were female. Most common indication was gall bladder carcinoma.

Overall, technical success achieved in 94% of cases.

ED was done in 28 patients, 19 underwent IED. Stenting (SEMS) was performed in 8 cases after IED. IED reduced mean bilirubin levels by 67% one week post procedure, ED resulted in decrease by 39% at the same time.

22% of patients had complication during/after procedure. Two patients had sepsis post procedure. Chemotherapy could be initiated in two patients following IED in one week.

Conclusion

PTBD is an effective procedure with high technical success. IED is better than ED in terms of rapid reduction of bilirubin, clinical improvement, possibility of stenting, less chances of expulsion and early initiation of chemotherapy.

Keywords

Percutaneous transhepatic biliary drainage; Internal External Drainage; External Drainage; Palliation; Biliary obstruction

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