Results of percutaneous manoeuvres in biliary disease: the Paul Brousse experience.

BACKGROUND: Percutaneous manoeuvres are alternatives to the endoscopic approach in the management of complex biliary disease.

METHODS: We retrospectively reviewed our experience with 1,014 percutaneous interventions performed between 1980 and 2005 at a tertiary-level hepatobiliary centre. The main outcome measures were the success rate of percutaneous manoeuvres and the procedure-related morbidity and mortality. Eight hundred seventy-two patients who underwent 1,014 percutaneous procedures were divided into four groups according to the indication and goal of therapy: Group A: percutaneous manoeuvres aimed at improving the patient's general condition (worsened by severe jaundice, pruritus, or cholangitis); Group B: cancer patients receiving chemotherapy who required biliary drainage as jaundice was a contraindication for continuing chemotherapy; Group C: manoeuvres performed to confirm diagnosis of biliary obstruction; and Group D: manoeuvres performed with the goal of complete treatment of calculus disease.

RESULTS: Interno-external drainage (526 procedures) was the most common intervention and dilatation the most frequently associated manoeuvre (456 procedures). Mean duration of biliary drainage was 159±152 days. Overall success rate (total+partial success) was 86%; the best and worst results were in Groups C (95% success) and A (70% success), respectively. The mortality rate was 7.5%; 29 (37%) deaths were procedure-related (cholangitis being the principal cause). End-stage malignancy was the major cause of mortality (58%). Procedure-related morbidity rate was 17%, and Group C (0%) and Group D (5%) patients had the least number of complications.

CONCLUSIONS: In complex biliary disease, the percutaneous approach is a feasible and safe therapeutic option and should be added to the armamentarium of experienced hepatobiliary teams. A well-planned strategy consisting of repeated interventions, prolonged biliary drainage, and optimal antibiotic therapy are prerequisites for success with this approach.