title: Percutaneous biliary drainage effectively lowers serum bilirubin to permit chemotherapy treatment.
abstract: OBJECTIVE
  For digestive tract cancers, the bilirubin threshold for administration of systemic chemotherapy can be 5 or 2 mg/dL (85.5 or 34.2 μmol/L) depending upon the regimen. We examined the ability of percutaneous biliary drainage (PBD) in patients with malignant biliary obstruction to achieve these clinically relevant endpoints.
  
  
  METHODS
  106 consecutive patients with malignant biliary obstruction and a baseline serum bilirubin >2 mg/dL underwent PBD. Time to achieve a bilirubin of 5 mg/dL (85.5 μmol/L), 2 mg/dL (34.2 μmol/L), and survival was estimated by Kaplan-Meier analysis. Potential technical and clinical prognostic factors were subjected to univariate and multivariate analysis. Categorical variables were analyzed by the log rank test. Hazard ratios were calculated for continuous variables.
  
  
  RESULTS
  Median survival was 100 days (range 1-3771 days). Among 88 patients with a pre-drainage bilirubin >5 mg/dL, 62% achieved a serum bilirubin ≤5 mg/dL within 30 days and 84% within 60 days, median 21 days. Among 106 patients with a pre-drainage bilirubin >2 mg/dL, 37% achieved a serum bilirubin ≤2 mg/dL by 30 days and 70% within 60 days, median 43 days. None of the technical or clinical factors evaluated, including pre-drainage bilirubin, were significant predictors of time to achieve a bilirubin ≤2 mg/dL (p = 0.51). Size and type of biliary device were the only technical variables found to affect time to bilirubin of 5 mg/dL (p = 0.016).
  
  
  CONCLUSIONS
  PBD of malignant obstruction achieves clinically relevant reduction in serum bilirubin in the majority of patients within 1-2 months, irrespective of the pre-drainage serum bilirubin, sufficient to allow administration of systemic chemotherapy. However, the decision to undergo this procedure for this indication alone must be considered in the context of patients' prognosis and treatment goals.
authors: Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA.
authors: Jennifer L
authors: JL
authors: Levy
authors: Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA.
authors: Deepak
authors: D
authors: Sudheendra
authors: Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA.
authors: Mandeep
authors: M
authors: Dagli
authors: Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA.
authors: Jeffrey I
authors: JI
authors: Mondschein
authors: Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA.
authors: S William
authors: SW
authors: Stavropoulos
authors: Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA.
authors: Richard D
authors: RD
authors: Shlansky-Goldberg
authors: Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA.
authors: Scott O
authors: SO
authors: Trerotola
authors: Division of Gastrointestinal Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
authors: Ursina
authors: U
authors: Teitelbaum
authors: Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors: Rosemarie
authors: R
authors: Mick
authors: Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA. michael.soulen@uphs.upenn.edu.|Department of Radiology, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA. michael.soulen@uphs.upenn.edu.
authors: Michael C
authors: http://orcid.org/0000-0001-8136-2123
authors: MC
authors: Soulen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D001663:Bilirubin / Q000097:blood*; D018281:Cholangiocarcinoma / Q000097:blood* / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D002779:Cholestasis / Q000097:blood* / Q000401:mortality / Q000473:pathology; D004322:Drainage; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D015996:Survival Rate
chemical_list: D001663:Bilirubin
keywords: Biliary tract diseases; Bilirubin; Chemotherapy; Cholangiocarcinoma; Drainage; Pancreatic neoplasms