Assessment of Malignant Biliary Obstruction by Percutaneous Transhepatic Cholangiography: A Prospective Cohort Study

Abstract

Introduction: Malignant Biliary Obstruction (MBO) is caused by hepatic metastasis, gall bladder carcinoma, other distant metastasis, icteric hepatocellular carcinoma and lymphoma. Different signs and symptoms of obstruction includes pruritus, jaundice, altered food taste, renal dysfunction, anorexia, malnutrition which ultimately leads to impaired immune dysfunction and impaired quality of life. Aim: To determine the extent of biliary ductal involvement in patients with MBO through Magnetic Resonance Cholangiopancreatography (MRCP) and Percutaneous Transhepatic Cholangiography (PTC) technique and to compare the number of biliary drainage required. Materials and Methods: A prospective cohort study was undertaken at Department of Radiodiagnosis, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India. It included total 40 patients (24 females and 16 males) with strong clinicopathological and laboratory investigation suspicious of MBO. Patients with suspected MBO were examined with MR cholangiography. All patients then underwent PTC and Biliary Drainage (PTBD) and/or stent placement after MR cholangiography. The statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Results: As out of 40 patients, 16 (40%) were males and 24 (60%) were females and the mean age was 53.87±9.49 years with maximum age noted to be 75 years and minimum age of patient in study was 35 years. The most common block observed on MRCP was type IIIA (35%) and after MRCP the distribution of level of hilar block on PTC was obtained with the most common block found was of type II (32.5%). Maximum number of biliary drains during PTBD was three. In MRCP three biliary drain were used in 47.5% patients while in PTC it was used only in 40% patients. Conclusion: Based on diagnostic performance, PTC was found to be superior for the assessment of MBO. PTC played an important role in scheduling the therapeutic strategy for malignant biliary stricture.

Keywords

• benign biliary obstruction
• pancreatic adenocarcinoma
• secondary hepatic malignancies