title: Percutaneous transhepatic biliary drainage (PTBD) with or without stenting-complications, re-stent rate and a new risk stratification score.
abstract: OBJECTIVE
  To review the success rate and number of complications in patients with obstructive jaundice treated with percutaneous transhepatic biliary drainage (PTBD), and to stratify the procedural risk of both PTBD and biliary stenting.
  
  
  METHODS
  948 procedures performed in 704 consecutive patients with obstructive jaundice over a 7 year period were reviewed: 345 male; 359 females, mean age 70.1 years (range 48-96 years). Statistical analysis included X ( 2 ) test and multivariate logistic regression analysis.
  
  
  RESULTS
  The technical success rate was 99%. The mortality related to the procedure was 2% and the 30-day mortality 13%. 91 (13%) stents inserted occluded during the study period. Predictors for stent failure and re-stenting were a diagnosis of cholangiocarcinoma, a lesion in the distal CBD, a high bilirubin, high urea and high white cell count and post procedure cholangitis. Factors significantly related to complications and 30-day mortality were retrospectively reviewed to devise a risk stratification score.
  
  
  CONCLUSIONS
  PTBD and stenting offer a safe and effective method in providing palliative treatment for patients with biliary obstruction. Patients likely to have high levels of morbidity and mortality can be predicted before PTBD, using a risk stratification score, highlighting the need for closer clinical observation and delayed stent placement.
authors.affiliation: Department of Radiology, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK.
authors.forename: C R
authors.initials: CR
authors.lastname: Tapping
authors.forename: O R
authors.initials: OR
authors.lastname: Byass
authors.forename: J E I
authors.initials: JE
authors.lastname: Cast
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects / Q000379:methods; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods; D015331:Cohort Studies; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D041781:Jaundice, Obstructive / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010166:Palliative Care / Q000379:methods*; D012008:Recurrence; D019233:Retreatment / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome