Pre and post percutaneous transhepatic biliary drainage outcomes and complications in patients with obstructive jaundice at Moi Teaching and Referral Hospital

Abstract

Background: Obstructive jaundice is a specific type of jaundice, where symptoms develop due to a narrowed or blocked biliary tree, preventing the normal drainage of bile from the liver into the intestines. It can have benign causes such as gallstones or malignant causes such as pancreatic cancer. Malignant causes are the majority and by the time of diagnosis, they are usually advanced with most patients exhibiting a poor clinical status. Percutaneous Transhepatic Biliary Drainage (PTBD) is an imagingguided procedure performed by an interventional radiologist for biliary drainage in both benign and malignant cases including palliation. It is a relatively new specialty in Kenya and as such a study on PTBD and information on the clinical and laboratory parameters pre and post drainage as well as on the associated immediate complications, is due for Kenya and Sub-Saharan Africa. Objectives: To evaluate outcomes pre and post PTBD and assess the complications from the PTBD procedure. Materials and Methods: A prospective study was conducted at the Moi Teaching and Referral hospital, in the Interventional Radiology section for a period of 12 months. All the patients with obstructive jaundice requiring PTBD who were sent to the interventional radiology unit for PTBD placement from the medical and surgical wards were recruited. Biodata and data on pruritus were collected using questionnaires whereas data on laboratory measurements were extracted from the patient records during the 2 week follow-up period. Analysis was done using Statistical Package for Social Sciences version 21. Descriptive statistics including mean, mode, and median, measures of dispersion, frequencies, and proportions were used for the analysis. The results are presented in form of tables, figures, and prose format. Results: Among the 66 patients included in the study, 53% were male while the rest were female. The majority of the patients showed clinical improvement in pruritus post PTBD. There was a statistically significant reduction in aspartate aminotransferase (AST), alanine phosphatase (ALP), total bilirubin, and Gamma Glutamyl transferase (GGT) after PTBD with ( A p value< 0.005). A total of 35 (53.0%) of the patients had major complications while 25 (42.4%) had minor complications after the PTBD procedure. Conclusion: PTBD improved patient clinical and laboratory parameters and minor complications were mostly encountered in this study Recommendations: PTBD uptake should be encouraged and further studies should be done to determine the quality of life post-PTBD procedure to relate whether improved laboratory and clinical outcomes translate to a better quality of life.