Color Doppler ultrasound-guided PTBD with and without metal stent implantation by endoscopic control: prospective success and early adverse event rates

Abstract

Objective: There are just a few reports on Color Doppler Ultrasound-guided PTBD with and without metal stent implantation by endoscopic control. Ultrasound guidance facilitates percutaneous bile duct access and avoids severe adverse events. Internal biliary drainage rate in PTBD should be as high as possible as endoscopic ultrasound-guided cholangiodrainage (EUCD) offers internal drainage regularly. We report our prospective study analyzing success, internal drainage and adverse event rates.

Materials and methods: Between June 2009 and November 2014 overall 63 PTBDs were performed prospectively in 37 patients (18 m, 19f; age on average: 72 years) with benign (9 %) and malignant (91 %) bile duct obstruction. Ultrasound was used in combination with fluoroscopic guidance. Whenever possible, primary or early secondary metal stent implantation via PTBD by endoscopic control was performed as a one step-procedure.

Results: 38 of 41 (93 %) initial PTBDs (in four patients PTBD was performed twice) were successful. 22 of 63 PTBDs were follow-up examinations with different interventions. In 34 of 38 successful (89 %) PTBDs, an internal drainage (or metal stent) was implanted. 12 metal stent implantations via PTBD were performed under endoscopic control. Just 2 (5 %) permanent external drainages were inserted. In 63 performed PTBDs 5 (7.9 %) early major adverse events (no severe intrahepatic bleeding) were documented and treated without any procedure related death. When metal stent implantation was performed via PTBD no adverse event was documented.

Conclusion: Color Doppler guided PTBD is an effective and safe method for biliary drainage avoiding severe adverse events. Primary or early secondary metal stent implantation via PTBD reduces complication risks additionally. Endoscopic control of stent implantation via PTBD is helpful for optimal stent placement.

Zusammenfassung

Einführung: Es gibt bislang wenige Publikationen zur Farbkontrastdopplersonografisch (FKDS) gesteuerten PTCD mit und ohne Metallstentimplantation unter endoskopischer Kontrolle. Die Ultraschallkontrolle erleichtert dabei den perkutanen Zugang zum Gallenweg unter Vermeidung von relevanten Blutgefäßkomplikationen. Die Rate der internen Galleableitung sollte dabei möglichst hoch ausfallen, da die kompetitive Methode der EUCD die interne Ableitung regelhaft ermöglicht. Wir berichten über unsere prospektive Studie zur PTCD unter Berücksichtigung von Erfolgs- und Komplikationsraten sowie der Rate interner Ableitungen.

Material und Methoden: Zwischen Juni 2009 und November 2014 haben wir 63 PTCDs bei 37 Patienten (18 m, 19 f; im Mittel 72 Jahre) mit benignen (9 %) und malignen Gallenwegobstruktionen (91 %) durchgeführt. Dabei wurde die Ultraschallführung mit radiologischer Durchleuchtung kombiniert. Wenn möglich, wurde die primäre oder frühe sekundäre Metallstentimplantation via PTCD unter endoskopischer Kontrolle als eine One step-Prozedur durchgeführt.

Ergebnisse: 38 von 41 (93 %) initialen PTCDs (bei 4 Patienten 2-malig) waren erfolgreich. 22 von 63 PTCDs waren Follow-up-Untersuchungen mit unterschiedlichen Interventionen. Bei 34 von 38 erfolgreichen PTCDs (89 %) wurde eine interne Drainage (oder ein Metallstent) eingelegt. 12 Metallstentimplantationen via PTCD wurden unter endoskopischer Kontrolle durchgeführt. Nur 2 (5 %) permanente externe Drainagen wurden eingesetzt. Bei 63 PTCDs wurden 5 (7,9 %) frühe Majorkomplikationen (ohne relevante schwere Blutung) dokumentiert und erfolgreich behandelt. Bei den Metallstentimplantationen via PTCD wurden keine Komplikationen beobachtet.

Schlussfolgerung: Die FKDS-gesteuerte PTCD ist eine effektive und sichere Methode zur Gallenwegableitung unter Vermeidung relevanter Blutungskomplikationen. Die primäre oder frühe sekundäre Metallstentimplantation via PTCD reduziert zusätzliche Komplikationsrisiken. Dabei ist die endoskopische Kontrolle hilfreich für die optimale Stentplatzierung.

Schlüsselwörter

perkutane transhepatische Cholangiodrainage (PTCD) - Gallenwegsobstruktion - Ultraschall

Key words

percutaneous transhepatic biliary drainage (PTBD) - bile duct obstruction - ultrasound

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