[Treatment of refractory malignant biliary obstraction: comparing results of percutaneous transhepatic biliary drainage with external catheters or endoscopic metallic stenting].
OBJECTIVE
To compare the initial results and adverse events of percutaneous transhepatic biliary drainage with external catheters or metallic stents for refractory malignant biliary obstruction.


METHODS
To review the data of those patients with refractory malignant biliary obstruction treated with external catheters or metallic stents in Changhai hospital from Sept. 1999 to Aug. 2002. Liver function tests were determined 2 to 4 days prior to and 5 to 7 days after the procedures and adverse events were recorded. A total of 13 metallic stents were implanted in 13 patients (9 men, 4 women, mean age, 62.5 years) and 16 external catheters were implanted in 15 patients (9 men, 6 women, mean age, 60.8 years).


RESULTS
The mean serum total bilirubin concentration prior to and after the procedures were (279.19 +/- 108.15) micro mol/L and (158.02 +/- 99.97) micro mol/L in the metallic stents group, (261.09 +/- 106.48) micro mol/L and (172.81 +/- 106.48) micro mol/L in the external catheters group. The mean serum direct bilirubin concentration were (226.83 +/- 84.03) micro mol/L and (132.57 +/- 80.16) micro mol/L, (208.03 +/- 95.03) micro mol/L and (142.61 +/- 83.74) micro mol/L in the two groups. There is no significant difference of the mean serum total and direct bilirubin concentrations between the two groups prior to the procedures (P > 0.05), but either the mean serum total or direct bilirubin concentration after the procedures in the two groups was significantly lower than that prior to the procedures (P < 0.01). The percentage of changes was significantly greater in the metallic stents group than that in the external catheters group (P < 0.01). Two patients with 3 complications occurred in the metallic stents group, including bile leakage and bleeding (1) and duodenal obstruction (1). Five complications occurred in the external catheters group, including catheter migration (2), catheter occlusion (1), bile leakage (1) and bleeding (1).


CONCLUSIONS
Percutaneous transhepatic biliary drainage is a reliable and safe therapy for refractory malignant biliary obstruction. The initial results suggest that the potential patency of percutaneous transhepatic biliary drainage with self-expandable metal stent is more rapid and effective than that with external catheters.
Zou
Xiao-ping
XP
Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China. zxpfcp@hotmail.com
Zhan
Xian-bao
XB
Li
Zhao-shen
ZS
Jin
Zhen-dong
ZD
Wan
Xin-jian
XJ
Wang
Na
N
Xu
Guo-ming
GM
D000328:Adult; D000368:Aged; D002404:Catheterization; D002779:Cholestasis / Q000503:physiopathology / Q000628:therapy*; D004322:Drainage / Q000009:adverse effects; D004724:Endoscopy; D005260:Female; D006801:Humans; D008099:Liver / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D015607:Stents / Q000009:adverse effects