Journal of Abdominal Radiology
Fat does not dissolve in water. In our body, where digestive medium is water-based, bile acids are used to emulsify the fat into small enough droplets for absorption and breakdown. This bile acids are produced by the liver, stored in the gallbladder, and is released to the GI tract through the biliary tract. The biliary tract is an important passage of the hepatobiliary system and is crucial for fat digestion. Its blockage, therefore, can cause numerous problems from diarrhea, malnutrition, vitamin deficiency, infection of the duct, and cholecystitis (gallbladder inflammation). The occlusion can occur due to bile stones obstructing the path, bile acid solution becoming too viscous, stricture (narrowing) of the ducts, or due to compression from outside (tumor, aneurysm, organomegaly). To make the pathway patent again, ERCP (Endoscopic Retrograde Cholangiopancreatography) is used, going through the gut and mechanically opening the way. IF ERCP fails, however, the following are the next steps:
This paper explores complication profiles of (2): PTCD. The paper also elucidates number of re-interventions required and associated risk/protective factors. 331 patients who have taken PTCD in Netherlands were examined. Proportions of complications are as follows:
The mortality/complication rate may seem high. So, why even perform PTCD? Remember that this paper explores complications with PTCD as a rescue procedure, not a primary procedure. Patients’ condition was in a bad state to need multiple procedures in a first place, and the failed ERCP may also have contributed to the complications. That being said, other studies also showed that the PTCD procedures had higher rates of complications.
This paper shows that the PTCD after failed ERCP is related to a high number of adverse events. This may highlight the importance of quality control for PTCD, and necessitating pre-procedural prophylactic antibiotic treatment.
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