Complications after percutaneous biliary drainage placement: a personal experience and a literature review

Abstract

Background: Percutaneous transhepatic biliary drainage (PTBD) is an essential procedure for managing biliary obstructions, particularly in cases where endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful or contraindicated. While PTBD is effective, it is associated with a range of complications, necessitating continuous evaluation of its safety and efficacy. Objective: This study aims to provide a comprehensive analysis of the complications and outcomes associated with PTBD during a single specialist’s learning curve. Additionally, a thorough review of the literature on PTBD complications will be conducted, and best practices for preventing and managing complications will be explored, focusing on improving clinical outcomes. Materials and methods: A retrospective analysis of 45 patients who underwent PTBD between 2022 and 2024 was conducted. All procedures were performed under combined ultrasound and fluoroscopy guidance. Data on procedural success, complications, and in-hospital mortality were collected. Complications were classified as minor or major based on clinical significance. The analysis focused on the types of early complications and mortality occurring during the patient’s hospital stay directly related to the procedure. Results: Technical success was achieved in 43 patients (95.5%). Complications were observed in 18 patients (41.9%), with 8 cases (18.6%) classified as major. The most common complication was hemobilia (30.2%), followed by cholangitis, which occurred in 5 patients (11.6%) during their hospital stay. Minor complications were managed conservatively, while major complications required invasive interventions such as embolization for severe hemobilia and percutaneous drainage for abscesses and bilomas. Two patients (4.6%) died during hospitalization due to underlying conditions unrelated to the procedure. Discussion: The findings align with existing literature, emphasizing PTBD’s effectiveness despite a high overall complication rate. Preventive strategies, including adequate pre-procedural preparation and precise catheter placement, are crucial for minimizing risks. This study underscores the importance of early recognition and prompt management of complications, particularly cholangitis and bleeding. Conclusion: PTBD is a safe and effective intervention for biliary obstructions when performed with meticulous technique and appropriate patient selection. Despite its inherent risks, most complications can be effectively managed, reinforcing PTBD’s role in complex biliary cases. Further studies are needed to optimize strategies for reducing complications and improving clinical outcomes.