British Society of Interventional Radiology: Biliary Drainage and Stenting Registry (BDSR)

Abstract

Objectives

This study was designed to audit current practice in percutaneous biliary drainage and stenting in the United Kingdom.

Methods

In 2006, the British Society of Interventional Radiology set up the first web-based Biliary Drainage and Stenting Registry (BDSR). This consisted of a series of tick sheets, which were completed online. Data collection included technical and clinical success of the procedures and outcomes at discharge with a separate form for any follow-up visits. Two months before data analysis, all contributors were asked via email to complete any outstanding data. This paper reports on data collected between November 1, 2006 and August 18, 2009.

Results

A total of 833 procedures were recorded and were entered by 62 operators from 44 institutions within the United Kingdom. There were 455 men and 378 women with a median age of 69 (range 20–101) years.The majority of procedures were performed by a consultant. Successful drainage of the biliary tree was achieved in 98.7%. Partial or complete relief of symptoms was seen in 65% of patients. Minor complications, predominantly pain (14.3%), were seen in 26% and major complications, predominantly sepsis (3.5%), were seen in 7.9% of patients.

Conclusions

These figures provide an essential benchmark for both audit and patient information. Identifying areas of good practice and those that require improvement will ultimately result in better patient care.

Appendices

Appendix 1

See Fig. 4

Fig. 4

 

Appendix 2

Definitions

Ascites:

mild/moderate <10-mm depth over right liver

Gross >10-mm depth over right liver

Biliary dilatation:

Mild/Moderate: Peripheral ducts just visible, CBD >8–15 mm<

Marked: Peripheral ducts grossly dilated or >2 mm and or CBD >15 mm

Obstruction:

No immediate contrast passage at direct injection into the biliary tree at ERCP or PTC

Stricture:

>50% luminal reduction of the duct

Technically successful drainage:

Placement of drain into the biliary tree and external/internal free flow of bile

Technically successful stent:

Placement of stent/s in intended position with free passage of bile into the duodenum

Primary stent:

Stent placed at the time of initial drainage procedure

Staged stent:

Stent placed after initial drainage procedure

Combined:

Stent placed with endoscopic assistance

Bilateral stent:

Stents placed from a right and left biliary duct approach

Sepsis:

Defined by the presence of two or more of the following

• Body temperature <36°C (97°F) or >38°C (100°F) (hypothermia or fever).

• Heart rate >100 beats per minute (tachycardia).

• Respiratory rate >20 breaths per minute or, on blood gas, P_aCO₂ <32 mmHg (4.3 kPa) (tachypnea or hypocapnia due to hyperventilation).

• White blood cell count <4,000 cells/mm³ or >12,000 cells/mm³ (<4 × 10⁹ or >12 × 10⁹ cells/l), or >10% band forms (immature white blood cells) (leukopenia, leukocytosis, or bandemia).

Hemorrhage:

bleeding from the access site

Hematoma:

Excludes simple skin discoloration

Mild: Not requiring transfusion

Moderate: Requires transfusion

Severe: Transfusion and intervention surgical/endovascular

Re-intervention:

Unplanned additional procedure after initial drainage and/or stenting episode

Functional patency:

Relief of symptoms

Complications

Clinical Outcome Following a Complication

Minor (No Clinical Consequence)

• a. No therapy, e.g., small hematoma

• b. Minimal therapy management of a vasovagal attack or contrast reaction, or <24 h admission for observation

Major (Significant Patient Consequence Requiring Therapy)

• c. Unplanned hospitalization >24 to <48 h, e.g., for transfusion

• d. Unplanned hospitalization >48 h, e.g., surgical bypass graft

• e. Permanent adverse sequelae

• f. Death

Renal Impairment

A deterioration in renal function detected within 10 days of the procedure, indicated by a 25% increase in creatinine level over baseline.