Citation Information :
Singh J, Tripathy TP, Patel R, Chandel K. Is Ultrasound-guided Bedside Percutaneous Transhepatic Biliary Drainage Safe and Feasible in Critically Ill Patients with Severe Cholangitis? A Preliminary Single-center Experience. Indian J Crit Care Med 2023; 27 (1):16-21.
Background and aim: Severe cholangitis secondary to biliary obstruction carries high mortality unless biliary drainage is performed urgently. Owing to various patient-related and logistical issues, bedside biliary drainage is considered a salvage therapeutic option. This study aims to evaluate the safety and efficacy of ultrasonography (USG)-guided biliary drainage at the bedside in patients with severe cholangitis admitted to the intensive care unit (ICU).
Materials and methods: A total of 20 patients with severe cholangitis admitted to ICU who underwent bedside percutaneous transhepatic biliary drainage (PTBD) under USG guidance were retrospectively evaluated. Clinical outcomes, details about the PTBD procedure, and complications were recorded and analyzed.
Results: Among 20 patients, 13 were male and 7 were female with a mean age of 50.5 years. The most common cause of biliary obstruction was gall bladder malignancy (45%, n = 9) followed by cholangiocarcinoma (25%, n = 5). Left- and right-sided PTBD was performed in 40% (n = 8) and 35% (n = 7) patients, respectively, while 25% (n = 5) of patients underwent bilateral PTBD. The technical success rate was 100%. A total of 65% (n = 13) of patients were discharged from ICU upon improvement while the remaining 35% (n = 7) died despite bedside PTBD. None of the patients had any major procedure-related complications.
Conclusions: Ultrsound-guided bedside PTBD seems to be a safe and effective option in critically ill patients with severe cholangitis when shifting of patients is not feasible.
Gupta P, Gupta J, Kumar MP. Imaging in obstructive jaundice: What a radiologist needs to know before doing a percutaneous transhepatic biliary drainage. J Clin Interv Radiol ISVIR 2020;4:31–37. DOI: 10.1055/s-0039-3401327.
Sato KT. Percutaneous management of biliary emergencies. Semin Intervent Radiol 2006;23(3):249–257. DOI: 10.1055/s-2006-948764.
Bansal V, Schuchert VD. Jaundice in the intensive care unit. Surg Clin North Am 2006;86(6):1495–502. DOI: 10.1016/j.suc.2006.09.007.
Gupta P, Maralakunte M, Rathee S, Samanta J, Sharma V, Mandavdhare H, et al. Percutaneous transhepatic biliary drainage in patients at higher risk for adverse events: Experience from a tertiary care referral center. Abdom Radiol (NY) 2020;45(8):2547–2553. DOI: 10.1007/s00261-019-02344-1.
Chacko J, Brar G. Bedside ultrasonography–applications in critical care: Part II. Indian J Crit Care Med 2014;18(6):376–381. DOI: 10.4103/0972-5229.133897.
Sreenivas DV, Kumar A. Urgent bedside endoscopic nasobiliary drainage without fluoroscopic monitoring. Hepatogastroenterology 1998;45(24):2042–2043. PMID: 9951861.
Chawla YK, Sharma BC, Singh R, Sharma TR, Dilawari JB. Emergency endoscopic nasobiliary drainage without the aid of fluoroscopy. Indian J Gastroenterol 1993;12(3):97–98. PMID: 8354540.
Shah R, Qayed E. Bedside endoscopic retrograde cholangiopancreatography using portable X-ray in acute severe cholangitis. Case Rep Gastrointest Med 2018;2018:8763671. DOI: 10.1155/2018/8763671.
Miura F, Okamoto K, Takada T, Strasberg SM, Asbun HJ, Pitt HA, et al. Tokyo Guidelines 2018: Initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci 2018;25(1):31–40. DOI: 10.1002/jhbp.509.
Chen JH, Sun CK, Liao CS, Chua CS. Self-expandable metallic stents for malignant biliary obstruction: efficacy on proximal and distal tumors. World J Gastroenterol 2006;12(1):119–122. DOI: 10.3748/wjg.v12.i1.119.
Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. CIRSE quality assurance document and standards for classification of complications: The CIRSE classification system. Cardiovasc Intervent Radiol 2017;40(8):1141–1146. DOI: 10.1007/s00270-017-1703-4.
Patel IJ, Rahim S, Davidson JC, Hanks SE, Tam AL, Walker TG, et al. Society of interventional radiology consensus guidelines for the periprocedural management of thrombotic and bleeding risk in patients undergoing percutaneous image-guided interventions – Part II: Recommendations: Endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 2019;30(8):1168–1184.e1. DOI: 10.1016/j.jvir.2019.04.017.
Khilnani GC, Zirpe K, Hadda V, Mehta Y, Madan K, Kulkarni A, et al. Guidelines for antibiotic prescription in intensive care unit. Indian J Crit Care Med 2019;23(Suppl. 1):S1–S63. DOI: 10.5005/jp-journals-10071-23101.
Makuuchi M, Bandai Y, Ito T, Watanabe G, Wada T, Abe H, et al. Ultrasonically guided percutaneous transhepatic bile drainage: A single-step procedure without cholangiography. Radiology 1980;136(1):165–159. DOI: 10.1148/radiology.136.1.7384494.
Ralls PW, Mayekawa DS, Lee KP, Johnson MB, Halls J. The use of color Doppler sonography to distinguish dilated intrahepatic ducts from vascular structures. AJR Am J Roentgenol 1989;152(2):291–292. DOI: 10.2214/ajr.152.2.291.
Giurazza F, Corvino F, Contegiacomo A, Marra P, Lucarelli NM, Calandri M, et al. Safety and effectiveness of ultrasound-guided percutaneous transhepatic biliary drainage: A multicenter experience. J Ultrasound 2019;22(4):437–445. DOI: 10.1007/s40477-019-00399-w.
Koito K, Namieno T, Nagakawa T, Morita K. Percutaneous transhepatic biliary drainage using color Doppler ultrasonography. J Ultrasound Med 1996;15(3):203–206. DOI: 10.7863/jum.1918.104.22.168.
Gupta P, Maralakunte M, Kalra N, Samanta J, Sharma V, Mandavdhare H, et al. Feasibility and safety of bedside percutaneous biliary drainage in patients with severe cholangitis. Abdom Radiol (NY) 2021;46(5):2156–2160. DOI: 10.1007/s00261-020-02825-8.
Nennstiel S, Treiber M, Faber A, Haller B, von Delius S, Schmid RM, et al. Comparison of ultrasound and fluoroscopically guided percutaneous transhepatic biliary drainage. Dig Dis 2019;37(1):77–86. DOI: 10.1159/000493120.
Shimizu H, Kato A, Takayashiki T, Kuboki S, Ohtsuka M, Yoshitomi H, et al. Peripheral portal vein-oriented non-dilated bile duct puncture for percutaneous transhepatic biliary drainage. World J Gastroenterol 2015;21(44):12628–12634. DOI: 10.3748/wjg.v21.i44.12628.
Sabarudin A, Gani RA, Abdullah M, Rumende CM. Changes in tumor nekrosis factor alpha and interleukin 6 levels in patients with obstructive jaundice due to pancreatobiliary cancer who underwent biliary drainage. Indones J Gastroenterol Hepatol Dig Endosc 2016;17(2):92–98. DOI: 10.24871/172201692-98.