Prospective Study of Outcomes after Percutaneous Biliary Drainage for Malignant Biliary Obstruction

P. C. Robson BA, BSN, RN, N. Heffernan BSN, RN, M. Gonen PhD, R. Thornton MD, L. A. Brody MD, R. Holmes BS, K. T. Brown MD, A. M. Covey MD, D. Fleischer NP, G. I. Getrajdman MD, W. Jarnagin MD, C. Sofocleous MD, L. Blumgart MD, M. D’Angelica MD
Hepatobiliary Tumors
Volume 17, Issue 9 / September , 2010

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Abstract

Background

Percutaneous biliary drainage (PBD) is used to relieve malignant bile duct obstruction (MBO) when endoscopic drainage is not feasible. Little is known about the effects of PBD on the quality of life (QoL) in patients with MBO. The aim of this study was to evaluate changes in QoL and pruritus after PBD and to explore the variables that impact these changes.

Materials and Methods

Eligible patients reported their QoL and pruritus before and after PBD using the Functional Assessment of Cancer Therapy–Hepatobiliary instrument (FACT-HS) and the Visual Analog Scale for Pruritus (VASP). Instruments were completed preprocedure and at 1 and 4 weeks following PBD.

Results

A total of 109 (60 male/49 female) patients enrolled; 102 (94%) had unresectable disease. PBD was technically successful (hepatic ducts cannulated at the conclusion of procedure) in all patients. There were 2 procedure-related deaths. All-cause mortality was 10% (N = 11) at 4 weeks and 28% (N = 31) at 8 weeks post-PBD with a median survival of 4.74 months. The mean FACT-HS scores declined significantly (P < .01) over time (101.3, 94.8, 94.7 at baseline, 1 week, 4 weeks, respectively). The VASP scores showed significant improvement at 1 week with continued improvement at 4 weeks (P < .01).

Conclusions

PBD improves pruritus but not QoL in patients with MBO and advanced malignancy. There is high early mortality in this population.

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