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Madhusudhan KS, Jineesh V, Keshava SN. Indian College of Radiology and Imaging Evidence-Based Guidelines for Percutaneous Image-Guided Biliary Procedures. Indian J Radiol Imaging 2021; 31:421-440. [PMID: 34556927 PMCID: PMC8448229 DOI: 10.1055/s-0041-1734222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Percutaneous biliary interventions are among the commonly performed nonvascular radiological interventions. Most common of these interventions is the percutaneous transhepatic biliary drainage for malignant biliary obstruction. Other biliary procedures performed include percutaneous cholecystostomy, biliary stenting, drainage for bile leaks, and various procedures like balloon dilatation, stenting, and large-bore catheter drainage for bilioenteric or post-transplant anastomotic strictures. Although these procedures are being performed for ages, no standard guidelines have been formulated. This article attempts at preparing guidelines for performing various percutaneous image-guided biliary procedures along with discussion on the published evidence in this field.
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Affiliation(s)
| | - Valakkada Jineesh
- Department of Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology (Thiruvananthapuram), Kerala, India
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Makris GC, Macdonald AC, Allouni K, Corrigall H, Tapping CR, Hughes JP, Anthony S, Boardman P, Patel R, Wigham A, Husainy MA, See TC, Cast J, Olliff S, Travis S, Laasch HU, Nice C, Uberoi R. Clinical Performance Status and Technical Factors Affecting Outcomes from Percutaneous Transhepatic Biliary Interventions; A Multicentre, Prospective, Observational Cohort Study. Cardiovasc Intervent Radiol 2021; 44:1625-1632. [PMID: 34254176 PMCID: PMC8478732 DOI: 10.1007/s00270-021-02888-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/28/2021] [Indexed: 11/08/2022]
Abstract
Purpose The purpose of this study was to evaluate the predictive value of a ‘Modified Karnofsky Scoring System’ on outcomes and provide real-world data regarding the UK practice of biliary interventions. Materials and Methods A prospective multi-centred cohort study was performed. The pre-procedure modified Karnofsky score, the incidence of sepsis, complications, biochemical improvement and mortality were recorded out to 30 days post procedure. Results A total of 292 patients (248 with malignant lesions) were suitable for inclusion in the study. The overall 7 and 30 day mortality was 3.1% and 16.1%, respectively. The 30 day sepsis rate was 10.3%. In the modified Karnofsky ‘high risk’ group the 7 day mortality was 9.7% versus 0% for the ‘low risk’ group (p = 0.002), whereas the 30 day mortality was 28.8% versus 13.3% (p = 0.003). The incidence of sepsis at 30 days was 19% in the high risk group versus 3.3% at the low risk group (p = 0.001) Conclusion Percutaneous biliary interventions in the UK are safe and effective. Scoring systems such as the Karnofsky or the modified Karnofsky score hold promise in allowing us to identify high risk groups that will need more careful consideration and enhanced patient informed consent but further research with larger studies is warranted in order to identify their true impact on patient selection and outcomes post biliary interventions.
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Affiliation(s)
- Gregory C Makris
- Vascular and Interventional Radiology Department, Guy's and St Thomas' Hospital, NHS Foundation Trust, London, UK.,Alfa Institute of Biomedical Sciences, Neapoleos 9, Marousi, Athens, Greece
| | - Andrew C Macdonald
- Department of Interventional Radiology, Oxford University Hospitals NHS Foundation Trust, oxford, UK
| | - Kader Allouni
- University Hospitals North Midlands NHS Foundation Trust, Stoke-on-Trent, UK
| | - Hannah Corrigall
- Department of Interventional Radiology, Oxford University Hospitals NHS Foundation Trust, oxford, UK
| | - Charles R Tapping
- Department of Interventional Radiology, Oxford University Hospitals NHS Foundation Trust, oxford, UK
| | - Jane Philips Hughes
- Department of Interventional Radiology, Oxford University Hospitals NHS Foundation Trust, oxford, UK
| | - Suzie Anthony
- Department of Interventional Radiology, Oxford University Hospitals NHS Foundation Trust, oxford, UK
| | - Phil Boardman
- Department of Interventional Radiology, Oxford University Hospitals NHS Foundation Trust, oxford, UK
| | - Rafiudin Patel
- Department of Interventional Radiology, Oxford University Hospitals NHS Foundation Trust, oxford, UK
| | - Andrew Wigham
- Department of Interventional Radiology, Oxford University Hospitals NHS Foundation Trust, oxford, UK
| | - Mohammad Ali Husainy
- Department of Interventional Radiology, Oxford University Hospitals NHS Foundation Trust, oxford, UK
| | - Teik Choon See
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - James Cast
- Hull University Teaching Hospitals NHS Foundation Trust, Hull, UK
| | - Simon Olliff
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Simon Travis
- Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | | | - Colin Nice
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Raman Uberoi
- Department of Interventional Radiology, Oxford University Hospitals NHS Foundation Trust, oxford, UK.
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Elkilany A, Alwarraky M, Geisel D, Maaly MA, Denecke T. Stent performance in palliative transhepatic treatment of malignant biliary obstruction: a randomized study comparing covered versus uncovered stents. Acta Radiol 2020; 61:1591-1599. [PMID: 32212829 DOI: 10.1177/0284185120911187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Considering the limitations in both uncovered self-expandable metallic stents (USEMS) and covered self-expandable metallic stents (CSEMS), it is difficult to make a general recommendation for their application in percutaneous decompression of malignant biliary obstruction (MBO). PURPOSE To compare percutaneous transhepatic CSEMSs versus USEMSs for the palliative treatment of MBO in terms of technical success, clinical success, stent patency, patient survival, complications, and stent dysfunction. MATERIAL AND METHODS This prospective randomized study included 66 patients with unresectable MBO. CSEMSs were inserted in 31 patients (26 men, 5 women; mean age = 63.8 ± 7.96 years) and USEMSs were inserted in 35 patients (26 men, 9 women; mean age = 62.3 ± 11.7 years). RESULTS Mean primary stent patency duration was 138 ± 92.7 days in CSEMSs versus 150 ± 77.9 days in USEMSs (P = 0.578). Tumor overgrowth occurred exclusively in one patient with CSEMS (P = 0.470) and tumor ingrowth exclusively in two patients with USEMS (P = 0.494). Stent migration occurred in two patients with CSEMSs versus one patient with USEMSs (P = 0.579). Hemobilia occurred in five patients with CSEMSs versus three patients with USEMSs while bile leakage occurred in one patient in each group despite the larger introducer sheath caliber with CSEMSs (9 F vs. 6-7 F). There was no significant difference regarding patient survival (P = 0.969). CONCLUSION In our cohort of patients with rather poor life expectancy, there was no significant difference between covered and uncovered stents for the palliative treatment of MBO. However, considering the higher cost of CSEMs and the larger introducer diameter necessary for their placement, USEMSs can be preferred.
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Affiliation(s)
- Aboelyazid Elkilany
- Department of Diagnostic Medical Imaging and Interventional Radiology, National Liver Institute, Menoufia University, Menoufia, Egypt
- Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mohamed Alwarraky
- Department of Diagnostic Medical Imaging and Interventional Radiology, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Dominik Geisel
- Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mohamed A Maaly
- Department of Radiology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
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Abstract
Biliary drainage is important in the care of patients with benign and malignant biliary obstruction. Careful preprocedure evaluation of high-quality cross-sectional imaging and inventory of symptoms are necessary to determine whether a percutaneous, endoscopic, or surgical approach is most appropriate. High bile duct obstruction is usually best managed percutaneously; a specific duct can be targeted and enteric contamination of isolated ducts can be avoided. Options for percutaneous biliary intervention include external or internal/external biliary drainage, stent placement, biliary stone retrieval, and bile duct biopsy. Preprocedure evaluation, technique, and indications for percutaneous intervention in benign and malignant diseases are summarized.
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Affiliation(s)
- Rocio Perez-Johnston
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, H-118, New York, NY 10065, USA
| | - Amy R Deipolyi
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, 1275 York Avenue, H-118, New York, NY 10065, USA
| | - Anne M Covey
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, 1275 York Avenue, H-118, New York, NY 10065, USA.
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