SIR Today

Although placement of PTBDs has a high technical success rate, most patients will require additional interventions to optimize catheter placement and function. “Between one-third and one-half of patients will experience an adverse event during the management of their drain,” Dr. Henry said. “Many of these patients are in advanced stages of disease and do not benefit from PTBD.”

Researchers at the Medical College of Wisconsin aimed to improve patient selection by assessing patient factors predicting a higher likelihood of receiving oncologic treatment following percutaneous biliary drainage.

“Additionally, we wanted to gain clarity on the clinical course of PTBDs including the number of interventions patients undergo and the rates of internalization,” Dr. Henry said, which will improve the informed consent process.

The team conducted a retrospective single center review of 234 patients from 2018-2024 who had obstructive biliary malignancy that prevented cancer treatment.

According to Dr. Henry, following placement, only half of patients received oncologic treatment—which included chemotherapy, radiation, surgery or liver-directed therapy—and underwent approximately four procedures related to their drain. While pre-procedure bilirubin was associated with receiving treatment, the location of obstruction was not.

Placement and exchange of PTBDs is a common procedure performed by IRs—which is why it is crucial to understand the clinical background and considerations for each patient before proceeding with percutaneous drainage of malignant biliary obstruction.

“Having informed conversations with both clinicians and patients will improve patient selection, outcomes and quality of life,” said Dr. Henry.

Researchers plan to conduct further analysis, investigating the role of metastatic versus primary malignancy and prior treatment course on the clinical outcomes following PTBD placement, as they believe these variables are important considerations in the clinical course of this patient population.