Utilization pattern and efficacy of nonsurgical techniques to establish drainage for high biliary obstruction.
OBJECTIVE
To review the frequency and success of percutaneous and endoscopic techniques in the relief of high biliary obstruction.


METHODS
A search of the radiologic achieves was performed identifying 70 patients with cholangiographic demonstration of high biliary obstruction defined as proximal to the distal third of the extrahepatic bile duct. Record review determined the frequency and success rates of percutaneous and endoscopic techniques in providing biliary decompression for obstructive jaundice.


RESULTS
Endoscopic retrograde cholangiopancreatography was performed in 35 of 70 patients, providing initial endoscopic biliary decompression (EBD) in six patients (two subsequently required percutaneous intervention). Percutaneous biliary drainage (PBD) was attempted in 60 of 70 patients, providing initial decompression in 55 patients. PBD provided decompression after failed endoscopic biliary drainage in 18 of 26 patients. Endoscopic drainage was never attempted after failed percutaneous drainage. Overall EBD success was 23% and overall PBD success was 95%. The complication rate attributed to EBD was 26%; that attributed to PBD was 25%. For those patients who underwent attempts at both EBD and PBD, the complication rate was 16%.


CONCLUSIONS
At an institution with well-developed gastrointestinal medical services and interventional radiologic services, PBD was more successful in providing initial biliary decompression than endoscopic techniques for high biliary obstruction.
Henry Ford Hospital, Detroit, MI 48202, USA.
K M
KM
Nelsen
D J
DJ
Kastan
P C
PC
Shetty
M W
MW
Burke
R P
RP
Sharma
C
C
Venugopal
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications; D001653:Bile Ducts, Intrahepatic; D002277:Carcinoma / Q000150:complications; D002404:Catheterization / Q000009:adverse effects; D018281:Cholangiocarcinoma / Q000150:complications; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D001651:Cholestasis, Extrahepatic / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D004322:Drainage / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications; D012189:Retrospective Studies; D016896:Treatment Outcome