Poster Session I - A124PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE (PTBD) FOR MALIGNANT HILAR BILIARY OBSTRUCTION (MHBO) IS ASSOCIATED WITH POOR OUTCOMES – IS IT TIME TO REASSESS ITS CLINICAL UTILITY?

TL;DR

This study suggests that percutaneous transhepatic biliary drainage for malignant hilar obstruction leads to poor outcomes compared to other treatments.

Contribution

The study evaluates PTBD's effectiveness in MHBO and highlights its association with complications and poor outcomes.

Findings

PTBD achieved primary bilirubin reduction in 62% of MHBO patients.

PTBD was linked to complications, longer hospital stays, and shorter survival.

The study calls for reassessing PTBD as a standard treatment for MHBO.

Abstract

Decompression of malignant biliary obstruction is important for quality of life and potential chemotherapy (CTx). PTBD is an alternative when endoscopic stenting with ERCP is not possible. In MHBO, PTBD is the preferred intervention as multiple branches may be obstructed rendering ERCP stenting suboptimal.

Assess the impact of PTBD for MHBO on patient outcomes and compare them to management of extrahepatic obstruction.

Retrospective chart audit of all patients diagnosed with cholangiocarcinoma (CCA) at the University of Alberta Hospital from 07/2023-06/2024. Primary outcome was a reduction of the bilirubin to < 30 µmol/L. Secondary outcomes were successful initiation and completion of CTx, procedural complications, re-interventions, hospital length of stay (HLOS), and mortality.

30 pts (17 M), median age of 70±10 yrs (52-94 yrs) presented with CCA. Location of CCA was intrahepatic in 9, hilar in 13, and extrahepatic in 8 pts. No pts with intrahepatic CCA underwent PTBD and were not included in this review. We compared pts with MHBO and those with extrahepatic CCA (Table).

The primary outcome was achieved with PTBD in 62% pts with MHBO but significant complications requiring re-intervention precluded optimal CTx, and were associated with a longer HLOS and shorter survival. Further inquiry into cost implications, and assessment of PTBD as standard of care in pts with MHBO is required.

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