Original Article
Copyright ©2010 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Radiol. Sep 28, 2010; 2(9): 358-367
Published online Sep 28, 2010. doi: 10.4329/wjr.v2.i9.358
Percutaneous imaging-guided interventions for acute biliary disorders in high surgical risk patients
Ragab Hani Donkol, Nahed Abdel Latif, Khaled Moghazy
Ragab Hani Donkol, Department of Radiology, Aseer Central Hospital, PO Box 34, 31911, Abha, Saudi Arabia
Ragab Hani Donkol, Department of Radiology, Faculty of Medicine, Cairo University, Cairo 81, Egypt
Nahed Abdel Latif, Department of Radiology, Faculty of Medicine, Al Azhar University, PO Box 11884, Nasr City, Cairo 29, Egypt
Khaled Moghazy, Department of Radiology, Faculty of Medicine, Alexandria University, Egypt and Department of Radiology, King Faisal University, Dammam, PO Box 40076, Al-Khobar 31952, Saudi Arabia
Author contributions: Donkol RH contributed to the design of the study, as well as performing the procedures, analysis of data, manuscript writing, including drafting the article and revising it critically for important intellectual content; Latif NA and Moghazy K shared in manuscript writing and performing the procedures.
Correspondence to: Ragab Hani Donkol, Professor, Department of Radiology, Aseer Central Hospital, PO Box 34, 31911, Abha, Saudi Arabia. donkol@gawab.com
Telephone: +966-7220-1169 Fax: +966-7224-8092
Received: June 8, 2010
Revised: August 20, 2010
Accepted: August 27, 2010
Published online: September 28, 2010

AIM: To evaluate the efficacy of percutaneous imaging-guided biliary interventions in the management of acute biliary disorders in high surgical risk patients.

METHODS: One hundred and twenty two patients underwent 139 percutaneous imaging-guided biliary interventions during the period between January 2007 to December 2009. The patients included 73 women and 49 men with a mean age of 61 years (range 35-90 years).

Fifty nine patients had acute biliary obstruction, 26 patients had acute biliary infection and 37 patients had abnormal collections. The procedures were performed under computed tomography (CT)- (73 patients), sonographic- (41 patients), and fluoroscopic-guidance (25 patients). Success rates and complications were determined. The χ2 test with Yates’ correction for continuity was applied to compare between these procedures. A P value < 0.05 was considered significant.

RESULTS: The success rates for draining acute biliary obstruction under CT- , fluoroscopy- or ultrasound-guidance were 93.3%, 62.5% and 46.1%, respectively with significant P values (P = 0.026 and 0.002, respectively). In acute biliary infection, successful drainage was achieved in 22 patients (84.6%). The success rates in patients drained under ultrasound- and CT-guidance were 46.1% and 88.8%, respectively and drainage under CT-guidance was significantly higher (P = 0.0293). In 13 patients with bilomas, percutaneous drainage was successful in 11 patients (84.6%). Ten out of 12 cases with hepatic abscesses were drained with a success rate of 83.3%. In addition, the success rate of drainage in 12 cases with pancreatic pseudocysts was 83.3%. The reported complications were two deaths, four major and seven minor complications.

CONCLUSION: Percutaneous imaging-guided biliary interventions help to promptly diagnose and effectively treat acute biliary disorders. They either cure the disorders or relieve sepsis and jaundice before operations.

Keywords: Biliary drainage, Biliary obstruction, Biliary sepsis, Cholecystostomy, Interventional radiology