Percutaneous transhepatic cholangiodrainage in patients with PSC: a multicentre, retrospective analysis

Background and Aims Endoscopic retrograde cholangiography (ERC) is the method of choice to treat biliary strictures in patients with primary sclerosing cholangitis (PSC). However, in a subgroup of PSC patients, biliary stenoses are complex and endoscopic biliary drainage cannot be established using ERCP. There is no generally accepted recommendation how to proceed in this situation, highlighting a severe lack of data. The aim of this study was to investigate the risks, benefits and clinical outcomes of PSC patients after percutaneous transhepatic cholangiodrainage (PTCD) in an international, multicentre study.

Method Retrospective patient data was provided from four European centres. Medical records were reviewed for clinical data including laboratory results, previous endoscopic interventions, and periinterventional complications.

Results A total of 37 PSC patients who underwent PTCD were identified. Strictures were localised in the common bile duct (CBD) in most of the cases (CBD=51.4 %; bifurcation = 16.2 %; left=13,5 %; right=2,7 %; multiple=16.2 %). Liver cirrhosis was present in 14 patients (37.8 %) with a median MELD score of 16 at the time of first PTCD. In most cases jaundice (51.2 %) was the indication for PTCD, followed by recurrent bacterial cholangitis (16.3 %), suspected cholangiocarcinoma (CCA, 16.3 %) and pruritus (11.6 %). Mild periinterventional complications occurred in 20 patients (54 %; 19x bacterial cholangitis, 1x pancreatitis). Severe complications in three patients (bile duct perforation, dislocation of catheter, pleural puncture) resolved without sequelae. Overall, total bilirubin and CRP levels significantly decreased six months after PTCD (Fig. 1). Pruritus improved in four of five patients after PTCD.

Conclusion To our knowledge, this is the first multicentre study investigating clinical outcomes of PSC patients undergoing PTCD. The procedure was generally safe and mild complications prevailed. PTCD for PSC patients is effective by amending jaundice and pruritus and by improving biochemical signs of cholestasis and inflammation. These results indicate that PSC patients who lack endoscopic options for biliary drainage benefit from PTCD.

Figure 1 Total bilirubin and CRP before (median bilirubin 5.44 mg/dl, CRP 30.5 mg/dl) and six months after PTCD (median bilirubin 1.08 mg/dl, CRP 4 mg/dl). * = p  <  0.05.

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Artikel online veröffentlicht:
04. Januar 2021