Tezbir Singh MBBS, Presenter: Nothing to Disclose

Shivanand Ramachandra Gamanagatti MBBS, MD, Abstract Co-Author: Nothing to Disclose

Raju Sharma MD, Abstract Co-Author: Nothing to Disclose

Deepnarayan Srivastava, Abstract Co-Author: Nothing to Disclose

This study evaluated the efficacy of unilateral versus bilateral percutaneous transhepatic biliary drainage in the palliation of these patients in terms of improvement of quality of life and reduction of serum bilirubin levels

A prospective, single-center study was conducted in a cohort of 49 patients with malignant biliary obstruction. The primary confluence was blocked in 33 patients and patent in 16 patients. A single, unilateral internal-external catheter or metallic stent was placed in 44 patients. Bilateral catheter or stent insertion was done in 5 patients in whom the primary confluence was blocked and contrast had opacified the contralateral duct during the procedure to prevent cholangitis. In total 28 patients (57.1%) had unilateral biliary drainage and in the rest of 21(42.9%) bilateral drainage was achieved. Patients were evaluated at one month after the procedure and, thereafter every 3 months. We studied the impact of amount of biliary drainage on the change in the European Organisation for Research and Treatment of Cancer QOL questionnaire (EORTC QLQ-C30) (version 3) scores and by liver function tests.

Mean serum bilirubin level was 19.85 mg/dl prior to the procedure and at one month was 6.02 mg/dl after the procedure, and at 6 months was 3.84 mg/dl, which was statistically significant (p<0.001). There was a significant improvement in all the QOL parameters (Functional, Symptomatology and Global). The mean increase in the Functional parameter at one month was 19.35 (percentage increase was 46.19%). The mean decrease in the Symptomatology parameter was 21.47 (percentage reduction was 38.5%). The mean increase in the Global parameter was 25.8(percentage increase was 85.8%). We found that there was no statistically significant difference in the reduction of the serum bilirubin levels (p = 0.136), and also QOL scores between the patients treated with unilateral versus bilateral drainage.

Unilobar biliary drainage is safe, feasible, and achieves adequate drainage in the great majority of patients with unresectable malignant biliary obstruction in terms of improvement of quality of life and bilirubin levels as compared to bilobar biliary drainage.

Unilateral percutaneous deployment of catheters or metal stents has a high clinical success rate that provides adequate palliation and improves Quality of Life substantially.

Singh, T, Gamanagatti, S, Sharma, R, Srivastava, D, Comparison of Unilateral versus Bilateral Biliary Drainage in Patients with Malignant Biliary Obstruction: A Prospective Study.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14009334.html