title: Percutaneous transhepatic biliary drainage in the management of obstructive jaundice.
abstract: BACKGROUND
  Percutaneous transhepatic biliary drainage (PTBD) has been employed for decompression of the obstructed biliary tract to palliate jaundice and pruritus and for the management of cholangitis. We present our data to review the indications, therapeutic results and associated mortality and complications of this procedure. We have also studied the effect of size of drainage catheters on the improvement in liver functions and procedure related complications.
  
  
  METHODS
  PTBD was attempted in 41 patients (18 men, age 56 +/- 12 years; 23 women, age 55 +/- 11 years) with obstructive jaundice (37 malignant, 4 benign).
  
  
  RESULTS
  PTBD was successful in 39 (95%) patients. Mean serum bilirubin and alkaline phosphatase concentration declined significantly (p < 0.000001 for both) after 1 week, however thereafter decline was slow. Complete relief of pruritus and cholangitis was noted in most patients. Major complications such as cholangitis, bile leak into the peritoneum, malfunction of drainage catheter, intraperitoneal haemorrhage and renal failure, occurred in 11 (28%) patients, 2 (5%) of whom died. Large catheters (> 10 Fr) were superior to small size catheters (< 10 Fr) in relief of jaundice and had lower catheter related cholangitis.
  
  
  CONCLUSIONS
  We conclude that PTBD is useful for palliation of malignant obstructive jaundice with intractable symptoms and cholangitis. Catheters larger than 10 Fr should be used.
authors.affiliation: Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: S S
authors.initials: SS
authors.lastname: Baijal
authors.forename: R K
authors.initials: RK
authors.lastname: Dhiman
authors.forename: S
authors.initials: S
authors.lastname: Gupta
authors.forename: B C
authors.initials: BC
authors.lastname: Sharma
authors.forename: S
authors.initials: S
authors.lastname: Roy
authors.forename: D K
authors.initials: DK
authors.lastname: Agarwal
authors.forename: G
authors.initials: G
authors.lastname: Choudhuri
authors.forename: V A
authors.initials: VA
authors.lastname: Saraswat
authors.forename: S R
authors.initials: SR
authors.lastname: Naik
mesh_terms: D002761:Cholangitis / Q000628:therapy; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care