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 +/- A 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.