Research Article
Risk and Survival Benefits of Percutaneous Transhepatic Biliary Drainage (PTBD) & Diagnostic Utility of Endobiliary Brush Cytology
Anand A*, Sharma D and Rathod J
Department of Radiology, Government Medical College, India
*Corresponding author: Anand A, Department of Radiology, Government Medical College, Nagpur,
Maharashtra, India, E-mail: rtanand.aa@gmail.com
Copyright: © 2020 Anand A, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Article Information: Submission: 01/17/2020; Accepted: 02/03/2020; Published: 09/03/2020
Abstract
Objective: Patients of malignant biliary obstruction were prospectively & retrospectively analyzed to identify factors related to bile output and reduction
of serum bilirubin after PTBD and stenting. We also compared the survival of these patients after PTBD to investigate if biliary drainage had any impact on
the long-term survival
Materials and methods: 41 patients of malignant obstructive jaundice in whom PTBD was attempted were followed up at regular interval of 2, 6 & 12
months. Data on post-stenting complications, stent patency and patient survival were collected. Endobiliary brush cytology was performed in 18 patients
prior to dilatation and stenting.
Results: Mean age of presentation was 55 years for males and 52 years for females. Most common cause of biliary obstruction was cholangiocarcinoma.
There was significant decrease in bilirubin on postoperative day 5 with p-value less than 0.0001. Patients with dilated IHBR had better post procedural
outcome as compared to those with non-dilated IHBR. No significant association was found between extra or intra hepatic biliary dilatation and intra or
postoperative complications and long-term outcome. There was increase in postoperative survival in patients with internal drainage as compared to external
drainage. Cytology report showed malignant cells in 13 out of 14 patients.
Conclusion: PTBD is an effective procedure in malignant obstructive jaundice to reduce the bilirubin load. Long-term survival rate in case of patients
of malignant obstructive jaundice undergoing PTBD was significantly increased with 2,6 and 12 months survival rate 88.2%, 67.6% and 50%. Patients with
non-dilated system are at an increased risk of intra and postoperative bleeding as compared with the patients with dilated system. Metastasis and ascites in
case of patient with malignant obstructive jaundice are bad prognostic factors for PTBD. Endobiliary brush cytology is an important alternative to have histopathological
diagnosis in case of malignant obstructive jaundice undergoing PTBD.