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Comparison of unilateral and bilateral percutaneous transhepatic biliary drainage for management of malignant hilar biliary obstruction: Effects on inflammation and outcomes

Eur J Radiol. 2025 May 7;188:112131. doi: 10.1016/j.ejrad.2025.112131. Online ahead of print.

ABSTRACT

PURPOSE: This retrospective study aimed to compare the effects of unilateral and bilateral percutaneous transhepatic biliary drainage (PTBD) procedures on inflammatory markers and clinical outcomes in patients with malignant hilar biliary obstruction (MHBO).

METHODS: The study included 102 patients with MHBO who underwent PTBD at our institution. Patients were divided into unilateral (n = 46) and bilateral (n = 56) groups based on the drainage method. Demographic information and laboratory parameters were collected, and inflammatory markers were measured at baseline and follow-up intervals (24 h, 1 week, and 1 month). Statistical analyses were conducted to compare clinical and laboratory outcomes between the two groups.

RESULTS: In both groups all types of bilirubin levels showed significant decreaese after succesful cathetarization of at least one biliary duct and obervation of biliary drainage in all patients. Both unilateral and bilateral PTBD groups showed significant improvements in hepatic and cholestatic enzymes (ALT, AST, ALP, GGT), coagulation parameters (INR, APTT), and CRP levels over time (p < 0.05). However, most inflammatory markers, including CRP and procalcitonin, showed no significant differences between the two groups. Notably, only unilateral group exhibited significant improvements in platelet and lymphocyte counts from baseline to 1 month (p = 0.05 and p = 0.028, respectively). Correlation analysis revealed a strong negative association between CRP and albumin in the unilateral group (r = -0.713, p < 0.001), whereas the bilateral group showed a positive correlation between CRP and procalcitonin (r = 0.783, p < 0.001).

CONCLUSION: Our study demonstrates that there were no significant differences between unilateral and bilateral PTBD in recovery of hyperbilirubinemia. However, some inflammatory markers were adversely affected in the bilateral group. Based on these findings, unilateral PTBD may suffice as a first-line approach in patients with MHBO due to its less invasive nature and lower cost. Bilateral drainage should be reserved for cases where sufficient bilirubin reduction cannot be achieved.

PMID:40367561 | DOI:10.1016/j.ejrad.2025.112131

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