A team from Munich, Germany, investigated methods for rapid large-caliber percutaneous transhepatic drainage in patients with obstructive jaundice.
60 consecutive patients undergoing percutaneous drainage for biliary diseases were included in the prospective study, over a 19-month period.
A 10-Fr transpapillary drain was firstly established in the patients. Then individuals were randomly assigned to either conventional percutaneous transhepatic biliary drainage (PTBD) or stepwise dilation using the new method. The new system aimed at a need for only one further session, using a specially designed stiffenable metal guide wire of 6.6 Fr and plastic bougies.
The details of the procedure, initial and later complications, assessment by the patients, and procedural costs were compared between the two groups.
|Costs per patient, in German marks:|
Conventional PTBD: 5,813
New system: 2,581
29 patients were randomly assigned to Group I (the new method), and 31 to Group II (the conventional approach). There were no significant differences between the two groups in terms of clinical data or biliary pathology.
The researchers found that the clinical efficacy of PTBD was similar in the two groups. However, 3 patients in Group II were switched to the new procedure because of failure of dilation using the conventional approach.
The rates of major complications (4/29 in Group I, 5/31 in Group II) and patient tolerance were also similar.
The new procedure was found to lead to a significant reduction in the cumulative procedure duration (20 minutes vs. 30 minutes), the mean number of sessions (1.1 vs. 1.7), and the mean number of hospital days (2.0 vs. 5.5).
The new method was therefore also cost-effective, reducing costs from a mean of 5,813 to 2,581 German marks (DM) per patient.
Researcher E. Frimberger, of the Technical University of Munich, concluded on behalf of the group, "The new system for rapid establishment of large-caliber percutaneous transhepatic biliary drainage offers significant advantages in terms of saving hospital resources while maintaining clinical efficacy."