Unilobar Versus Bilobar Biliary Drainage: Effect on Quality of Life and Bilirubin Level Reduction

Shivanand Gamanagatti, Tejbir Singh, Raju Sharma, Deep N Srivastava, Nihar Ranjan Dash, Pramod Kumar Garg, Shivanand Gamanagatti, Tejbir Singh, Raju Sharma, Deep N Srivastava, Nihar Ranjan Dash, Pramod Kumar Garg

Abstract

Background: Percutaneous biliary drainage is an accepted palliative treatment for malignant biliary obstruction.

Purpose: To assess the effect on quality of life (QOL) and bilirubin level reduction in patients with inoperable malignant biliary obstruction treated by unilobar or bilobar percutaneous transhepatic biliary drainage (PTBD).

Materials and methods: Over a period of 2 years, 49 patients (age range, 22-75 years) of inoperable malignant biliary obstruction were treated by PTBD. Technical and clinical success rates, QOL, patency rates, survival rates, and complications were recorded. Clinical success rates, QOL, and bilirubin reduction were compared in patients treated with complete (n = 21) versus partial (n = 28) liver parenchyma drainage. QOL before and 1 month after biliary drainage were analyzed retrospectively between these two groups.

Results: Biliary drainage was successful in all 49 patients, with an overall significant reduction of the postintervention bilirubin levels (P < 0.001) resulting in overall clinical success rate of 89.97%. Clinical success rates were similar in patients treated with whole-liver drainage versus partial-liver drainage. Mean serum bilirubin level before PTBD was 19.85 mg/dl and after the procedure at 1 month was 6.02 mg/dl. The mean baseline functional score was 39.35, symptom scale score was 59.55, and global health score was 27.45. At 1 month, mean functional score was 61.25, symptom scale score was 36.0 4, and global health score was 56.33, with overall significant improvement in QOL (<0.001). There was a statistically significant difference in the improvement of the QOL scores (P = 0.002), among patients who achieved clinical success, compared with those patients who did not achieve clinical success at 1 month. We did not find any significant difference in the QOL scores in patients according to the amount of liver drained (unilateral or bilateral drainage), the type of internalization used (ring biliary or stent). Overall, minor and major complications rates were 14.3% and 8.1%, respectively.

Conclusion: Percutaneous biliary drainage provides good palliation of malignant obstructive jaundice. Partial-liver drainage achieved results as good as those after complete liver drainage with significant improvements in QOL and reduction of the bilirubin level.

Keywords: Biliary drainage; Bilirubin; Malignant biliary obstruction; Quality of life; Survival.

Figures

Figure 1
Figure 1
Axial computed tomography images showing spectrum of malignant biliary obstruction: (a) Mass replacing gallbladder (arrow) with encasement of hepatic artery, a case of carcinoma gallbladder; (b) enhancing mass at hilum (arrow) resulting biliary dilatation, a case of cholangiocarcinoma; (c) cholangiocarcinoma with involvement of bilateral secondary biliary confluence (arrows); (d) mass in head of pancreas (arrow) with involvement of superior mesenteric artery, a case of carcinoma pancreas; (e) lymph nodal mass at porta (arrow) resulting in biliary obstruction from unknown primary; (f) carcinoma gallbladder (not shown) with lung metastases (arrows)
Figure 2
Figure 2
Fluorospot images showing unilateral biliary drainage right sided approach (a) and left side approach (b)
Figure 3
Figure 3
Fluorospot images showing types of biliary drainage; unilateral biliary drainage (a) and bilateral biliary drainage (b)
Figure 4
Figure 4
Fluorospot images showing types of internalization of biliary drainage; Internalization done by ring biliary catheter (a) and internalization done by self-expandable metallic stenting (b)
Figure 5
Figure 5
Fluorospot images showing types of metallic stenting; unilateral metallic stenting (a) and Y-shaped bilateral metallic stenting (b)
Graph 1
Graph 1
Relation of quality of life with improvement in bilirubin at 1 month. (Key: X-axis: Percentage change in bilirubin level at 1 month. Y-axis: Quality of life change at 1 month)
Graph 2
Graph 2
Cumulative patency stratified according to biliary drainage
Graph 3
Graph 3
Cumulative patency stratified according to internalization procedure
Graph 4
Graph 4
Patency stratified according to 1 month bilirubin level (Key to Kaplan–Meier graphs: X-axis: Postpercutaneous transhepatic biliary drainage interval in days. Y-axis: Probability of survival)
Graph 5
Graph 5
Cumulative survival stratified according to bilirubin levels at 1 month (Key to Kaplan–Meier graphs: X-axis: Postpercutaneous transhepatic biliary drainage interval in days. Y-axis: Probability of survival)
Graph 6
Graph 6
Cumulative survival stratified according to biliary drainage
Graph 7
Graph 7
Cumulative survival stratified according to internalization

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