Improving rehabilitation and quality of life after percutaneous transhepatic cholangiography drainage with a rapid rehabilitation model

BACKGROUND Percutaneous transhepatic cholangiography drainage(PTCD)effectively treats biliary obstruction.However,patients must maintain the drainage tube after hospital discharge,which may interfere with daily life and work,potentially causing psychological distress.Postoperative rehabilitation is crucial,and strengthened nursing interventions can shorten recovery time.AIM The aim was to evaluate an inpatient model to shorten rehabilitation duration and improve quality of life after PTCD.METHODS A total of 118 patients with malignant obstructive jaundice who were admitted to our hospital between May 2018 and January 2021 were included and divided into observational(with therapy)and control(no therapy)groups of 59 each.RESULTS The observational group had fewer hospitalization days than the control group.The complication,the PTCD fixed-tube prolapse,and tube-related admission rates within 3 mo after PTCD were significantly lower in the observation group than in the control group(P<0.05).The fatigue,pain,nausea,vomiting,pruritus,emaciation,and fever scores after PTCD decreased in both groups compared with the scores before PTCD(P<0.05).The quality of life scores after the intervention were higher in the observation than in the control group(P<0.05).CONCLUSION The model promoted rehabilitation after PTCD,reduced post-PTCD complications,and the tube-related admissions in the 3 mo after the procedure,and improved the quality of life.

Percutaneous transhepatic cholangiography vs endoscopic ultrasound-guided biliary drainage:A systematic review

BACKGROUND Percutaneous transhepatic cholangiography is a diagnostic and therapeutic procedure that involves inserting a needle into the biliary tree,followed by the immediate insertion of a catheter.Endoscopic ultrasound-guided biliary drainage(EUS-BD)is a novel technique that allows BD by echoendoscopy and fluoroscopy using a stent from the biliary tree to the gastrointestinal tract.AIM To compare the technical aspects and outcomes of percutaneous transhepatic BD(PTBD)and EUS-BD.METHODS Different databases,including PubMed,Embase,clinicaltrials.gov,the Cochrane library,Scopus,and Google Scholar,were searched according to the guidelines for Preferred Reporting Items for Systematic reviews and Meta-Analyses to obtain studies comparing PTBD and EUS-BD.RESULTS Among the six studies that fulfilled the inclusion criteria,PTBD patients underwent significantly more reinterventions(4.9 vs 1.3),experienced more postprocedural pain(4.1 vs 1.9),and experienced more late adverse events(53.8%vs 6.6%)than EUS-BD patients.There was a significant reduction in the total bilirubin levels in both the groups(16.4-3.3μmol/L and 17.2-3.8μmol/L for EUSBD and PTBD,respectively;P=0.002)at the 7-d follow-up.There were no significant differences observed in the complication rates between PTBD and EUSBD(3.3 vs 3.8).PTBD was associated with a higher adverse event rate than EUSBD in all the procedures,including reinterventions(80.4%vs 15.7%,respectively)and a higher index procedure(39.2%vs 18.2%,respectively).CONCLUSION The findings of this systematic review revealed that EUS-BD is linked with a higher rate of effective BD and a more manageable procedure-related adverse event profile than PTBD.These findings highlight the evidence for successful EUS-BD implementation.

Percutaneous intraductal radiofrequency ablation for treatment of biliary stent occlusion: A preliminary result

AIM To assess the feasibility and effectiveness of a novel application of percutaneous intraductal radiofrequency (RF) for the treatment of biliary stent obstruction. METHODS We specifically report a retrospective study presenting the results of percutaneous intraductal RF in patients with biliary stent occlusion. A total of 43 cases involving biliary stent obstruction were treated by placing an EndoHPB catheter and percutaneous intraductal RF was performed to clean stents. The stent patency was evaluated by cholangiography and follow-up by contrast enhanced computed tomography or ultrasound after the removal of the drainage catheter. RESULTS Following the procedures, of the 43 patients, 40 survived and 3 died with a median survival of 80.5 (range: 30-243) d. One patient was lost to followup. One patient had the stent patent at the time of last follow-up. Two patients with stent blockage at 35 d and 44 d after procedure underwent percutaneous transhepatic drain insertion only. The levels of bilirubin before and after the procedure were 128 +/- 65 mu mol/L and 63 +/- 29 mu mol/L, respectively. There were no related complications (haemorrhage, bile duct perforation, bile leak or pancreatitis) and all patients' stent patency was confirmed by cholangiography after the procedure, with a median patency time of 107 (range: 12-180) d. CONCLUSION This preliminary clinical study demonstrated that percutaneous intraductal RF is safe and effective for the treatment of biliary stent obstruction, increasing the duration of stent patency, although randomized controlled trials are needed to confirm the effectiveness of this approach.

Post-operative imaging in liver transplantation: State-of-the-art and future perspectives

Orthotopic liver transplantation(OLT)represents a major treatment for end-stage chronic liver disease,as well as selected cases of hepatocellular carcinoma and acute liver failure.The ever-increasing development of imaging modalities significantly contributed,over the last decades,to the management of recipients both in the pre-operative and post-operative period,thus impacting on graft and patients survival.When properly used,imaging modalities such as ultrasound,multidetector computed tomography,magnetic resonance imaging(MRI)and procedures of direct cholangiography are capable to provide rapid and reliable recognition and treatment of vascular and biliary complications occurring after OLT.Less defined is the role for imaging in assessing primary graft dysfunction(including rejection)or chronic allograft disease after OLT,e.g.,hepatitis C virus(HCV)recurrence.This paper:(1)describes specific characteristic of the above imaging modalities and the rationale for their use in clinical practice;(2)illustrates main imaging findings related to post-OLTcomplications in adult patients;and(3)reviews future perspectives emerging in the surveillance of recipients with HCV recurrence,with special emphasis on MRI.

Non-surgical treatment of post-surgical bile duct injury: Clinical implications and outcomes

AIM: To investigate the prognostic factors determining the success rate of non-surgical treatment in the management of post-operative bile duct injuries (BDIs).