Adverse Events After Percutaneous Transhepatic Biliary Drainage: A 10-Year Retrospective Analysis

Purpose: To determine the adverse event (AE) rates and profiles associated with percutaneous transhepatic biliary drainage (PTBD) and to identify risk factors for their occurrence. Materials and Methods: This single-center retrospective study included 2,310 PTBD (right-sided, 1,164; left-sided, 966; bilateral, 180) interventions for biliary obstruction (benign/malignant) in 449 patients between 2010 and 2020. Patients with percutaneous cholecystostomy alone were excluded. There were 455 initial drain placements (66 with cholangioplasty) and 1,855 exchanges (202 with cholangioplasty). Stents were placed in 163 procedures (metal, 156; plastic, 86). Demographic and procedural variables were assessed using multivariate logistic regression. Results: A total of 745 AEs were recorded. The 3 most common AEs were pericatheter bile leak (331/745, 44.4%), catheter occlusion (110/745, 14.7%), and drain dislodgement (103/745, 13.8%). There was a significantly higher overall AE rate among patients with malignant biliary obstruction than among those with benign biliary obstruction (29.8% vs. 17.6%; odds ratio [OR], 1.57 [1.13–2.18]; P = .006). Intraprocedural cholangioplasty was associated with a decreased AE rate for initial drains and overall procedures (OR, 0.48 [0.25–0.90]; P = .022, and OR, 0.63 [0.45–0.89]; P = .009). Finally, a right-sided drain was associated with an increased overall AE rate for initial drains and overall procedures (OR, 1.62 [1.02–2.55]; P = .039, and OR, 1.43 [1.05–1.91]; P = .017). Conclusions: Malignant obstruction and right-sided drains are associated with a higher risk of PTBD-related AEs, whereas intraprocedural cholangioplasty reduces risk. These findings offer insights into how this high-impact procedure can be performed more safely and effectively.