Obstructive jaundice in patients receiving hepatic artery infusional chemotherapy: Etiology, treatment implications, and complications after transhepatic biliary drainage

PURPOSE: The authors determined the incidence and cause of obstructive jaundice requiring percutaneous biliary drainage (PBD) occurring in patients treated with hepatic artery infusional (HAI) chemotherapy. The radiographic findings in the different causes of obstruction are characterized, and predictors of outcome are identified. MATERIALS AND METHODS: Charts and radiographs were reviewed for 30 patients who developed obstructive jaundice while receiving HAI chemotherapy and who subsequently required biliary drainage, The cause of obstruction, complications related to PBD, and survival from the time of PBD were recorded for each patient. RESULTS: Of 282 patients treated with HAI chemotherapy, 30 (10.6%) developed obstructive jaundice requiring PBD, Obstruction was related to chemotherapy-induced biliary sclerosis in 24 patients (80%). Five patients (17%) had bleeding complications related to PBD, Average survival was 32 weeks after biliary drainage, All four patients who had bilomas at the time of PBD had been treated with high-dose mitomycin, and lived an average of 10 weeks after the procedure. CONCLUSION: Chemotherapy-induced biliary sclerosis is the most common cause of obstructive jaundice in patients receiving HAI chemotherapy, These patients have a higher incidence of bleeding complications and may develop pseudoaneurysms remote from the ductal puncture site, Development of intrahepatic bilomas is associated with high-dose mitomycin-C treatment, and the presence of a biloma at the time of PBD is a poor prognostic indicator.