Short Term Clinical And Technical Outcomes Of Percutaneous Transhepatic Cholangiography And Biliary Drainage, For The Management Of Biliary Obstruction In Kenyatta National Hospital

Abstract

Background: Obstructive jaundice is a common presentation in patients referred to the Interventional Radiology (IR) unit in Kenyatta National Hospital (KNH). It is a significant cause of morbidity in patients suffering from various hepatobiliary diseases. Percutaneous relief of the biliary obstruction through percutaneous transhepatic cholangiography (PTC) and biliary drainage (BD) leads to clinical improvement in quality of life. However, percutaneous external biliary drainage, can also lead to increased morbidity and mortality in some patients. Despite the use of PTBD locally, there is paucity of data regarding its clinical and technical success rates and associated complications. Objective: This study sought to evaluate the technical and clinical success rates of PTBD procedure and determine the short-term clinical outcomes of patients undergoing PTBD at KNH. Methodology: This was a retrospective and prospective cross-sectional study. Retrospective data on PTBD clinical outcomes was abstracted from patient files from 12 months prior to this study. Same data was prospectively gathered from patients’ files for 3 months until the sample size was achieved. The study was undertaken at the KNH radiology department on patients undergoing PTBD over the study period. A preformed data collection sheet was used to capture relevant information. Analysis was done using IBM Statistical Package for Social Sciences (SPSS) (Version 27.0). for descriptive analysis, mean and corresponding standard deviation or median and corresponding interquartile range were used for normally distributed and skewed continuous data respectively. For categorical data, frequency and percentage was used. Paired sample t test and Wilcox ranked test were used to determine if the changes in laboratory parameters pre and post intervention were statistically significant study findings will be presented in descriptive text, charts, tables, and percentages. Descriptive statistics will be used for the analysis. Frequencies and percentages will be used to analyse categorical variable data such as presenting complaints, complications, management outcomes and symptoms. For continuous variables such as haemoglobin level and age, mean and standard deviation will be used if the data will be normally distributed. Results: The mean age of the patients who underwent PTBD was 56 (SD=13.6) years. A total of 14 (26.9%) had Hillar mass and Klatskin tumour, 12 (23.1%) had Pancreatic head carcinoma, 11 (21.2%) cholangiocarcinoma, and 5 (7.7%) strictures 5 (9.6%) had metastasis, and 5 (9.6%) had gall bladder carcinoma or mass. All 52 patients had yellowness of eyes, 43 viii (82.7%) had pruritus, and 18 (34.6%) abdominal pains. Biliary drainage was technically successful in 51 (98.1%) of the cases. The clinical success rate was 81.6%. A Wilcoxon signed-rank test showed that the intervention resulted in statistically significant reduction in total bilirubin (Z = -6.033, P-value<0.001) and direct bilirubin (Z = -5.799, P-value<0.001). The immediate post-procedure complications included 2 (3.8%) cases of septic shock, 2 (3.8%) cases of vessel puncture, 2 (3.8%) cases of bleeding through the tube, 1(1.9%) case of tumoral bleeding and 1 (1.9%) case of death. One-month post-procedure, 5 (9.6%) cases of catheter dislodgement, 5 (9.6|%) cases of Peri tubal discomfort/pain, 2(3.8%) cases of peri-tubal leakage, 2 (3.8%) cases of peri tubal infection and 2 (3.8%) cases of cholangitis were reported. Conclusion: PTBD is a highly effective and safe approach to biliary drainage with high clinical and technical success rates as was the case in this study and most previous studies in other settings. While there were minimal complication rates among the patients who underwent the procedure in this study, the commonly observed complications could be treated conservatively.