title: Percutaneous biliary drainage catheter insertion in patients with extensive hepatic metastatic tumor burden.
abstract: BACKGROUND
  Patients with metastatic disease of the liver can have hyperbilirubinemia due to a number of reasons, including biliary obstruction. The purpose of this study was to analyze patient outcomes after percutaneous biliary drainage (PBD) catheter insertion in patients with extensive hepatic metastatic tumor burden.
  
  
  METHODS
  Out of 746 PBD insertions, 44 patients (24 males, 20 females, mean age 57.4 years, range, 34-80 years) had metastatic malignancy with a hepatic tumor burden of greater than 20% parenchymal volume based on pre-procedure computed tomography (CT) or magnetic resonance imaging (MRI). Laboratory data before and after PBD insertion were compared. Survival and outcomes analysis performed. A subanalysis was performed on patients with CT-demonstrated catheter traversal of tumoral tissue.
  
  
  RESULTS
  A PBD catheter was successfully inserted in all patients. The mean serum bilirubin level decreased significantly from 10.9±6.4 mg/dL immediately prior to PBD insertion to 7.1±5.6 mg/dL (P<0.001) within one month post PBD insertion. Four patients (11%) demonstrated normalization of bilirubin levels to less than 1.6 mg/dL. Of the 14 patients with a post-procedure CT or MRI, the PBD catheter traversed a tumor in 11 (79%). One of these patients required a transfusion after the procedure and one had recurrent catheter exchanges due to pericatheter leakage. The 30-day overall survival was 41% with a median survival of 19 days. The percentage decrease in serum bilirubin after PBD insertion and pre-procedure international normalized ratio (INR) were correlated with improved survival (OR =3.7, P=0.010 and OR =4.9, P=0.028 respectively). The PBD-associated major complication rate was 16%.
  
  
  CONCLUSIONS
  In patients with hyperbilirubinemia and extensive hepatic metastatic disease burden, survival was dismal after PBD catheter insertion. Serum bilirubin level normalization occurred rarely.
authors.affiliation: Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Eun L
authors.initials: EL
authors.lastname: Langman
authors.affiliation: Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Paul V
authors.initials: PV
authors.lastname: Suhocki
authors.affiliation: Division of Medical Oncology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Herbert I
authors.initials: HI
authors.lastname: Hurwitz
authors.affiliation: Division of Medical Oncology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Morse
authors.affiliation: Division of Gastroenterology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Burbridge
authors.affiliation: Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Tony P
authors.initials: TP
authors.lastname: Smith
authors.affiliation: Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Charles Y
authors.initials: CY
authors.lastname: Kim
keywords: Hyperbilirubinemia; biliary obstruction; metastatic disease