The Benefits of Intervention Radiology in Treatment of Neoplastic Obstructive Jaundice

The Benefits of Intervention Radiology in Treatment of Neoplastic Obstructive Jaundice | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Benefits of Intervention Radiology in Treatment of Neoplastic Obstructive Jaundice Ahmed Reda Elneanaey, Ahmed Said Saafan, Inas Mohammed Sweed, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6486067/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Jaundice is frequently caused by malignant biliary tract obstruction. Many tools can be used in diagnosis; some of them are non-invasive while others are invasive. PTC at recent history is used as therapeutic technique. The objective of the investigation was to identify the advantages of intervention radiology in the management of neoplastic obstructive jaundice. Methods This was an interventional study was conducted on 30 patients aged from 37 to 75 old, both sexes, with malignant obstructive jaundice. History-taking was implemented for each patient, clinical Examination [general, and local abdominal examination], radiological investigation [abdominal ultrasound, and triphasic CT, and direct cholangiography], and laboratory assessment [serum bilirubin, serum alkaline phosphatase, serum liver enzymes, including serum glutamic pyruvic transaminase and serum glutamic oxaloacetic transaminase, and prothrombin time and concentration, both total and direct]. Results Total bilirubin was significantly decreased after intervention than before intervention (P value < 0.001). Regarding the interventional techniques, 28 (93.33%) Patients underwent both internal and external biliary drainage, 1 (3.33%) patient underwent internal & An external biliary drainage was performed on one patient (3.33%), Subsequently, a metallic stent is inserted into the common bile duct, and two additional metallic stents are inserted into the right and left hepatic ducts. Furthermore, one patient underwent both internal and external biliary drainage. Conclusions Interventional radiology provides significant symptomatic relief to patients with malignant biliary obstruction, thereby enhancing their quality of life. Intervention Radiology Neoplastic Obstructive Jaundice Biliary tract obstruction Percutaneous Transhepatic Cholangiography Figures Figure 1 Figure 2 Introduction The biliary system is composed of organs and ducts, including the gallbladder, bile ducts, and supporting structures, that are responsible for the production and transportation of bile (1). Many causes of biliary obstruction are identified, including gallstones, malignant obstruction by the pancreas, common bile ducts (CBD), and hepatic tumours. Additionally, biliary obstruction may result from inflammation of the bile ducts (2,3). Jaundice is frequently caused by cancerous obstruction of the biliary tract. Primary pancreatobiliary tract cancers and other localised cancers The biliary tract is compressed by liver, gallbladder, duodenal, ampullary, and metastatic cancers, as well as regional malignant lymphadenopathy, resulting in the diagnosis of 80,000 new cancer cases annually (4). There are numerous diagnostic tools available; Some are non-invasive, such as Magnetic Resonance Cholangiopancreatography (MRCP) and ultrasonography. Invasive procedures, including Endoscopic Retrograde Cholangiopancreatography (ERCP) and Percutaneous Transhepatic Cholangiography (PTC), are prescribed for therapeutic purposes (5). Jaundice is frequently caused by malignant biliary tract obstruction. Primary pancreatobiliary tract cancers and other localised cancers The biliary tract is compressed by liver, gallbladder, duodenal, ampullary, and metastatic cancers, as well as regional malignant lymphadenopathy, resulting in the diagnosis of 80,000 new cancer cases annually (5). PTC at recent history is used as therapeutic technique by placing self-expanding stents (metallic or plastic types) crossing malignant biliary strictures to enable palliative drainage. In comparison to ERCP, this percutaneous technique is less invasive and has the potential to supplant it (6,7,8). The objective of this investigation was to ascertain the advantages of intervention radiology in the management of neoplastic obstructive jaundice. Patients and Methods This Interventional “Quasi” study was conducted on 30 patients aged from 37 to 75 old, both sexes, with malignant obstructive jaundice who underwent different modalities of intervention radiological intervention (PTD and biliary stenting), with failed ERCP, Refused surgical procedures and inoperable patients with irresectable tumours, malignant obstructive jaundice, and cardiac or renal impairment. An informed written consent was obtained from the patient. The study was done after approval from the Ethical Committee Radiology Department, Benha University Hospitals from June 2023 to June 2024. Exclusion criteria were patients who declined to participate in the study due to haemorrhage and coagulation profile disorders, as well as pregnancy as a consequence of radiation exposure. All patients were subjected to: history taking [Age and complaint (yellowish discolouration of the epidermis and sclera manifests as dark urine, abdominal pain, abdominal enlargement, fever, and rigours), a history of operations, primary tumour, and prior biliary interventions, general examination [fever, cachexia, and anemia], local abdominal examination (Laboratory evaluation of hepatomegaly, splenomegaly, ascites, abdominal structures, and palpable gallbladder [serum bilirubin, both total and direct, Prothrombin time and concentration, serum liver enzymes, including serum glutamic pyruvic transaminase (SGPT) and serum glutamic oxaloacetic transaminase (SGOT), and alkaline phosphatase], and radiological assessment: [A recent abdominal ultrasound, triphasic Computed Tomography study, MRCP (not applicable to all), and direct cholangiography are all required prior to percutaneous drainage]. Pre-procedures preparation: Particularly prior to biliary drainage procedures, the coagulation profile was assessed. The platelet count was at least 80.000/mm3, and the prothrombin time was verified to be within permissible limits (no more than 4 seconds longer than the control). If necessary, Platelets, fresh frozen plasma, and vitamin K were administered to address the deficiencies. The procedures were conveyed to the patient or patient relatives in accordance with their condition, and patients were instructed to fast for 6–8 hours. The patient or their relatives executed informed assent. An intravenous cannula was implanted, aseptic conditions were verified, A pulse oximeter was accessible for patient monitoring, and an oxygen supply was readily available. Patients who are preparing for biliary drainage: One hour prior to the procedure, prophylactic broad-spectrum antibiotics were administered, and an intravenous fluid infusion was initiated promptly and maintained throughout the procedure, and the vital signs for the patients are measured before the procedure and checked always during the procedure to confirming the continuous liability of the patient during whole procedure. Percutaneous Transhepatic Cholangiography (PTC): The available imaging data were thoroughly reviewed before the procedure to confirm the degree and distribution of bile duct dilatation, prothrombin time was not exceeding 16 seconds, And in order to confirm the diagnosis and as a preliminary step prior to percutaneous interventional techniques, the prothrombin concentration was greater than 75% for all patients. antibiotics that are administered as a preventative; Injection of Ampicillin 1 gm and gentamicin 80 mg one hour before the procedure, followed by oral, antibiotic, ciprofloxacin or cephalosporins for two days, if there are signs of biliary infection, antibiotics were given according to culture and sensitivity test, the patient lie supine on X- ray table & prepared with antiseptic and surgical dressing, local anesthetic agent as Xylocaine 10 ml (Lidocaine hydrochloride 20 mg/ ml) was injected into the lower right intercostal muscles and under the subjacent liver capsule. With the respiration suspended, a 18 gauge sheathed needle is advanced under US guidance assisted into the dilated biliary radicles till its tip was visualized within the dilated radicle. Bile is aspirated after a duct has been perforated, and diluted contrast (Urographin 76%) is injected. Subsequently, images are acquired. Interventional Radiological Techniques: The obstructed biliary system was drained through percutaneous external biliary drainage. Femoral catheters (6–8 F) and pigtail catheters (8–12 F) were implemented. The outer sheath of the puncture needle was penetrated by a 0.035-inch guide wire in accordance with PTC. The biliary manipulation catheter (straight or Cobra catheter) was subsequently used to substitute the outer membrane. Subsequently, trials were conducted to circumvent the restriction. An internal-external biliary catheter or biliary endoprosthesis was inserted if the stricture was breached. If it was not, An external drainage catheter was affixed to the epidermis by sutures and positioned above the stricture. Before the endoprosthesis was inserted, the external drainage was performed as a preoperative decompression. The procedure was not completed due to the stricture not being bypassed, a lack of financial support, or the patients' refusal to undergo the procedure. In the event of duodenal infiltration, Percutaneous Internal-External Biliary Drainage was implemented to internally evacuate patients, which was a contraindication for endoprosthesis, or if the patient was unable to tolerate the high risk of bleeding or the dilatation of the liver track to a large size to be suitable for stent calibre. Pigtail catheters (with a diameter of 10 and 12 F) were implemented. After bypassing the stricture, the internal external drainage catheter was advanced over the guide wire so that its distal end was in the duodenum distal to the obstruction, and the proximal holes were in the biliary system above the stricture but not in the liver parenchyma. A cholangiogram was performed to confirm is position. The catheter was subsequently sealed and secured to the skin's surface with sutures. Endoprosthesis Metallic: The 5F catheter is employed to navigate the stricture over it when GW is able to bypass the obstruction in these patients. Several balloon dilatations were performed on strictured segments using a 3 cm balloon with an 8 mm diameter and a 4 cm balloon with a 10 mm diameter catheter. The memotherm self-expandable stent was initially introduced along the strictured segment. Further balloon expansion of the stents after insertion was done to accelerate their self-expansion using 10 mm balloon in three cases. Good flow of the contrast was insured. Plastic: Serial dilators were used to dilate the tract to the stent's diameter in these patients. A dilator of the same calibre as the stent was employed to ensure that the stent's proximal end was above the obstruction and its distal end was below it. The GW and inner 7–8 F catheter of the stiffener were covered with a plastic stent. The GW and pusher were subsequently removed, and the inner 7 F catheter was pulled above the stent. A control contrast examination was conducted to confirm the stent's position and patency. When it was difficult to cannulate with ERCP and the GW passed through the obstructed segment percutaneously, the Combined Endoscopic & Percutaneous Drainage Technique (Randez-Vous) was employed. The patient was placed supine, puncture then intubation of the biliary tract was done using a sheathed needle, manipulations by a torquable GW were done till crossing of the obstruction occurs, the GW was passed through the obstructed level and also fixed distally to the skin, The endoscope was inserted into the duodenum after the patient was situated in a prone position (anterior oblique position). Endoscopic role: Placing a plastic endoprosthesis (10 F) was achieved by engaging the wire with a snare or receptacle and withdrawing it through the endoscope. Post-drainage care: Patients who have either external or internal-external drainage are required to remain in bed for 24 hours, continue to take antibiotics for 2 days following the procedure, flush the catheter daily with sterile saline, and undertake cholangiography three days following the procedure when the biliary flow is visibly reduced. The subsequent parameters were examined: The frequency of complications, the laboratory response to drainage and the clinical response to drainage. Statistical analysis SPSS v28 (IBM Inc., Armonk, NY, USA) was employed to conduct the statistical analysis. The Shapiro-Wilks test and histograms were employed to evaluate the normality of the data distribution. The mean and standard deviation (SD) were presented as the result of the quantitative parametric data analysis using a paired t-test. Qualitative data were represented using frequency and percentage (%).A two-tailed P value of 0.05 or less was used to define statistical significance. Results Table 1 demonstrates that the age of the patients under investigation ranged from 44 to 80 years, with a mean ± standard deviation of 65.53 ± 10.37 years. There were 14 (46.67%) males and 16 (53.33%) females. Regarding the abdominal examination, 13 (43.33%) patients had hepatomegaly, 1 (3.33%) patient had splenomegaly, 12 (40%) patients had ascites, 15 (50%) patients had abdominal masses, and 18 (60%) patients had palpable gallbladder. Total bilirubin was with a mean ± SD of 8 ± 2.48 mg/dL. Direct bilirubin was with a mean ± SD of 7.1 ± 2.25 mg/dL. Table 1 Demographic data, abdominal examination, and laboratory data of the studied patients (n = 30) Patients (n = 30) Age (years) 65.53 ± 10.37 Gender Male 14 (46.67%) Female 16 (53.33%) Abdominal examination Hepatomegaly 13 (43.33%) Splenomegaly 1 (3.33%) Ascites 12 (40%) Abdominal masses 15 (50%) Palpable gallbladder 18 (60%) Laboratory investigation Total bilirubin (mg/dL) 8 ± 2.48 Direct bilirubin (mg/dL) 7.1 ± 2.25 Data are presented as mean ± SD or frequency (%) Regarding the previous operations, 4 (13.33%) patients underwent cholecystectomy, 1 (3.33%) patient underwent hemicolectomy, 3 (10%) patients underwent ERCP, 1 (3.33%) patient underwent Rendez vous procedure, 4 (13.33%) patients underwent Whipple operation, and 2 (6.67%) patients underwent breast surgeries. Regarding the previous biliary interventions, 1 (3.33%) patient underwent cholecystectomy, 1 (3.33%) patient underwent biliary stent, 2 (6.67%) patients underwent ERCP, 1 (3.33%) patient underwent ERCP with biliary stent, 1 (3.33%) patient underwent hepatobiliary anastomosis, and 1 (3.33%) patient underwent Rendez vous procedure. Regarding the type of tumor, 9 (30%) patients had cholangiocarcinoma, 2 (6.67%) patients had colorectal tumor, 10 (33.33%) patients had pancreatic mass, 1 (3.33%) patient had duodenal mass, 2 (6.67%) patients had ampullary mass, 3 (10%) patients had GB mass, and 3 (10%) patients had breast cancer. Table 2 Table 2 History of previous operations and biliary interventions, and type of tumor of the studied patients. n = 30 Previous operations Cholecystectomy 4 (13.33%) Hemicolectomy 1 (3.33%) ERCP 3 (10%) Rendez vous procedure 1 (3.33%) Whipple operation 4 (13.33%) Breast surgery 2 (6.67%) Previous biliary interventions Cholecystectomy 1 (3.33%) Biliary stent 1 (3.33%) ERCP 2 (6.67%) ERCP with biliary stent 1 (3.33%) Hepatobiliary anastomosis 1 (3.33%) Rendez vous procedure 1 (3.33%) Type of tumor Cholangiocarcinoma 9 (30%) Colorectal tumor 2 (6.67%) Pancreatic mass 10 (33.33%) Duodenal mass 1 (3.33%) Ampullary mass 2 (6.67%) GB mass 3 (10%) Breast cancer 3 (10%) Data are presented as frequency (%). ERCP: Endoscopic Retrograde Cholangiopancreatography Regarding the interventional techniques, 28 (93.33%) Patients underwent both internal and external biliary drainage, One patient (3.33%) underwent internal and external biliary drainage, followed by the insertion of a metallic stent in the CBD and two additional metallic stents in the right and left hepatic ducts. Additionally, one patient (3.33%) underwent external biliary drainage, followed by internal and external biliary drainage. Table 3 Table 3 Interventional techniques of the studied patients n = 30 Internal & external biliary drainage 28 (93.33%) Internal & external biliary drainage then metallic stent 1 (3.33%) External biliary drainage then internal & external biliary drainage 1 (3.33%) Data are presented as frequency (%). The mean ± SD of total bilirubin was 1.32 ± 0.2 mg/dL 15 days after the intervention. The total bilirubin level was significantly lower after the intervention than it was prior to the intervention (P < 0.001). Table 4 Table 4 Comparison of total bilirubin before and after intervention (n = 30) Before intervention 15 days after intervention P value Total bilirubin (mg/dL) 8 ± 2.48 1.32 ± 0.2 < 0.001* Data are presented as mean ± SD *: significant as P value < 0.005. Regarding the complications 7 (23.33%) patients developed biliary hemorrhage, and 1 (3.33%) patient was blocked and upsized. Table 5 Table 5 Complications of the studied patients n = 30 Biliary hemorrhage 7 (23.33%) Blocked and upsized 1 (3.33%) Data are presented as frequency (%). Case presentation Case 1: Clinical data: Male patient A 64-year-old individual was diagnosed with periampullary carcinoma through laboratory testing: The total bilirubin level was 8 mg/dL at the time of the procedure, and it was 1.8 mg/dL after 15 days. Additionally, internal-external drainage was implemented Fig. 1 Case 2: Clinical data: Female patient aged 67-years-old diagnosed to have cancer head pancreas, laboratory: Total bilirubin level reaches 6.5mg/dl., and total bilirubin level after 15 day 1.4mg/dl, and procedure: Percutaneous metallic stent was inserted in two steps after external biliary drainage. Figure 2 Discussion The gallbladder, bile ducts, and supporting structures are among the organs and ducts that compose the biliary system, which is accountable for the production and transportation of bile. The gallbladder, bile ducts, and supporting structures are among the organs and ducts that compose the biliary system, which is responsible for the production and transportation of bile ( 9 ) . Regarding the type of tumor, 9 (30%) patients had cholangiocarcinoma, 2 (6.67%) patients had colorectal tumor, 10 (33.33%) patients had pancreatic mass, 1 (3.33%) patient had duodenal mass, 2 (6.67%) patients had ampullary mass, 3 (10%) patients had GB mass, and 3 (10%) patients had breast cancer. Hazem et al. It was discovered that 12 patients had been diagnosed with pancreatic head cancer, which accounted for 40% of the patients. Additionally, Cholangicarcinoma (central and peripheral varieties) was diagnosed in 8 patients, representing 26.6% of the total. Four patients were diagnosed with periampullary carcinoma, which accounted for 13.3% of the patients. Four patients were diagnosed with an enlarged porta hepatis lymph node, which accounted for 13.3% of the patients. The final two patients were diagnosed with hepatic metastasis ( 10 ) . Regarding the previous biliary interventions, 1 (3.33%) patient underwent cholecystectomy, 1 (3.33%) patient underwent biliary stent, 2 (6.67%) patients underwent ERCP, 1 (3.33%) patient underwent ERCP with biliary stent, 1 (3.33%) patient underwent hepatobiliary anastomosis and 1 (3.33%) patient underwent Rendez vous procedure. Hazem et al. According to the findings, limited biliary dilatation was observed in approximately three patients (10%), mild dilatation in five patients (16.7%), moderate dilatation in thirteen patients (43.3%), and marked dilatation in the final nine patients (30%). Our study group was composed of 2 patients at the intrahepatic level (6.7%), 8 patients at the porta hepatis level (26.7%), 2 patients at the proximal CBD level (6.7%), 14 patients at the distal CBD level (46.6%), and the final 4 patients at the periampullary level (13.3%), categorised according to the degree of biliary obstruction ( 10 ) . Regarding the abdominal examination, 13 (43.33%) patients had hepatomegaly, 1 (3.33%) patient had splenomegaly, 12 (40%) patients had ascites, 15 (50%) patients had abdominal masses, and 18 (60%) patients had palpable gallbladder. In Wong review, Specific predictors of a probable poor prognosis following biliary stenting were identified in 90 stent deployments in 76 patients (male: female = 40: 36; age range = 43 to 94 years) with malignant biliary strictures. Ampullary carcinoma (6.6%), pancreatic carcinoma (55.3%), metastatic carcinoma (18.4%), cholangiocarcinoma (11.8%), and other causes (7.9%) (128) were the causes of malignant biliary obstruction. In the present study, it was determined that the mean ± SD of total bilirubin was 8 ± 2.48 mg/dL, with a range of 5.2 to 15.4 mg/dL. Direct bilirubin ranged from 4.6 to 13.5 mg/dL with a mean ± SD of 7.1 ± 2.25 mg/dL. Total bilirubin was significantly decreased after intervention than before intervention (P value < 0.001). Abdelghafar Salim et al. highlighted that during Laboratory investigation was conducted to monitor the patients' total bilirubin levels following the procedure. The therapeutic efficacy was determined by the 15-day total bilirubin level. Metallic stenting obtained the lowest mean total bilirubin level (3.8 mg/ml) among the various groups in this study, The mean total bilirubin level was at its highest (10 mg/dl) 15 days after percutaneous external drainage ( 9 ) . This can be partially attributed to the high flow rates and wide calibre of metallic stents, as well as the fact that a significant number of patients who underwent external drainage presented with liver cirrhosis or metastasis, which increased the mean post-drainage bilirubin. Regarding the interventional techniques, 28 (93.33%) patients underwent internal & external biliary drainage, 1 (3.33%) The patient underwent internal and external biliary drainage, followed by the insertion of a metallic stent in the CBD and two additional metallic stents in the right and left hepatic ducts. Additionally, one patient (3.33%) underwent external biliary drainage, followed by internal and external biliary drainage. For more than four decades, percutaneous biliary drainage procedures have been implemented, with modifications and enhancements to the techniques. Hazem et al. revealed that metallic stenting demonstrated a high success rate in reducing bilirubin levels and their associated complications in patients who were suitable for operation (Whipple) and had a postoperative biliary stricture resulting from choledocho-jujenostomy ( 10 ) . There was a technical success rate of 13/15 (81.2%) for percutaneous stricture crossing and stenting. This outcome surpasses that reported in the investigation Pinol et al., which achieved a technical success rate of 75% for percutaneous metallic stenting ( 11 ) . On the other hand, Schoder et al. , and Inal et al . The technical success rate for percutaneous metallic stenting was reported to be 100%. This discrepancy may be attributed to the degree of rigidity of biliary obstruction and tumour infiltration, as well as the variability of personal experience ( 12 , 13 ) . Metallic stents demonstrated substantial clinical advantages over plastic stents. Metallic stents with a broader calibre experience fewer occlusions. Therefore, Despite its higher initial cost, the metallic stent offers a cost-benefit advantage as a result of the reduced need for subsequent intervention. This same conclusion has been reached by a multitude of investigators, including Carr-Locke et al., Schmassmann et al., and Kaassis et al. , Metallic stents are advantageous over plastic stents solely when it is anticipated that the patient will endure for an extended period of time (e.g., six months) (14– 16 ) Regarding the complications, 7 (23.33%) patients developed biliary hemorrhage, and 1 (3.33%) patient was blocked and upsized. George et al. It was emphasised that the biliary tract stenting and drainage procedure is a safe procedure; however, it does have risks, which can be categorised as immediate and late complications. Pain at the puncture site, bile escape, intrahepatic and extrahepatic haemorrhage, including haemobilia, pneumothorax, haemothorax, septicaemia, and catheter-related issues such as kinking or dislocation, are all potential immediate complications. The left lobe punctures may be less unpleasant for patients, as they do not traverse the intercostal space. Nevertheless, the reduced liver's ability to tamponade the puncture canal may result in a higher incidence of bile leak or haemorrhage. Moderate to severe bile haemorrhage and bleeding may induce pain secondary to peritonitis, particularly referred pain at the shoulder tip. Traversing the pleura may lead to pneumothorax and haemothorax, which are uncommon. Among the late complications are cholangitis, pancreatitis, septicaemia, liver abscess, obstruction of drainage catheter or stent, and arterial or venous biliary fistula. Stent occlusion may be the consequence of tumour ingrowth or biliary sediment or calculi ( 17 ) . Abdelghafar Salim et al. revealed that the percutaneous drainage group experienced the highest rate of complications, with hemobilia being the most frequently occurring complication in the study ( 9 ) . Hazem et al. Hemobillia, subcapular leakage, dislodgment, stent occlusion, and cholangitis were the most frequently occurring complications ( 10 ) . We recommend that: Provide larger sample size with multicenter cooperation to validate our results; further research is required to generalize our results and well mention it; interventional radiology may have a pro. Limitations: The sample size was relatively modest. There was only one centre where the investigation was conducted. Conclusions Interventional radiology provides significant symptomatic relief to patients with malignant biliary obstruction, thereby improving their quality of life. Abbreviations Abbreviation Full Term CBD Common Bile Duct CT Computed Tomography ERCP Endoscopic Retrograde Cholangiopancreatography GB Gallbladder GW Guide Wire MRCP Magnetic Resonance Cholangiopancreatography PTC Percutaneous Transhepatic Cholangiography PTD Percutaneous Transhepatic Drainage SGOT Serum Glutamic Oxaloacetic Transaminase SGPT Serum Glutamic Pyruvic Transaminase Declarations Ethics approval and consent to participate It was approved by the ethics committee of Radiology Department, Benha University Hospitals and it was started at June 2023 to June 2024. An informed written consent was obtained from the participants. approval No. MD 10-3-2023. Consent for publication : All authors give their consent for publication in the journal. Availability of data and material: Data and material are available on a reasonable request from the author. Competing interests : The authors declare no conflict of interest. Funding: Nil. Authors' contributions: ARE and ASS conceived and supervised the study; IMS and HEE were responsible for data collection. EFA and ARE analysed and interpreted the data. All authors provided comments on the manuscript at various stages of development. All authors read and approved the final manuscript. Acknowledgements: Nil Conflict of Interest: Nil References Dawoud AM, Omar HM, Amin MA, Nooman A. Radiological intervention and imaging procedures in management of patients with malignant obstructive jaundice. Med J Cairo Univ. 2019;87(5):2791–800. Fekaj E, Jankulovski N, Matveeva N. Obstructive jaundice. Austin Dig Syst. 2017;2(1):1006. Rees J, Mytton J, Evison F, Mangat KS, Patel P, Trudgill N. The outcomes of biliary drainage by percutaneous transhepatic cholangiography for the palliation of malignant biliary obstruction in England between 2001 and 2014: a retrospective cohort study. BMJ Open. 2020;10(1):33–76. doi: 10.1136/bmjopen-2019-033076 . Shukla S, Kharat PR, Patbamniya N, Kumar K. Clinicopathological study on patients presenting with obstructive jaundice. Int Surg J. 2018;5(2):705–10. Barth KH. Percutaneous biliary drainage for high obstruction. Radiol Clin North Am. 1990;28(6):1223–35. Al Mahjoub A, Menahem B, Fohlen A, Dupont B, Alves A, Launoy G, et al. Preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma: is percutaneous transhepatic biliary drainage safer and more effective than endoscopic biliary drainage? A meta-analysis. J Vasc Interv Radiol. 2017;28(4):576–82. doi: 10.1016/j.jvir.2016.12.1220 . Wang L, Lin N, Xin F, Ke Q, Zeng Y, Liu J. A systematic review of the comparison of the incidence of seeding metastasis between endoscopic biliary drainage and percutaneous transhepatic biliary drainage for resectable malignant biliary obstruction. World J Surg Oncol. 2019;17:116. doi: 10.1186/s12957-019-1668-7 . Berquist TH, May GR, Johnson CM, Adson MA, Thistle JL. Percutaneous biliary decompression: internal and external drainage in 50 patients. AJR Am J Roentgenol. 1981;136(5):901–6. doi: 10.2214/ajr.136.5.901 . Salim MA, Elfeshawy MS, Elziat TM. Radiological interventional and imaging procedures in management of patient with malignant obstructive jaundice. Al-Azhar Int Med J. 2022;3(11):154–9. Hazem M, Ashraf MD, Nooman MA, Mohammed A. Radiological intervention and imaging procedures in management of patients with malignant obstructive jaundice. Med J Cairo Univ. 2019;87(9):2791–800. Schoder M, Rossi P, Uflacker R, Bezzi M, Stadler A, Funovics MA, et al. Malignant biliary obstruction: treatment with ePTFE-FEP–covered endoprostheses—initial technical and clinical experiences in a multicenter trial. Radiology. 2002;225(1):35–42. doi: 10.1148/radiol.2251010992 . İnal M, Akgül E, Aksungur E, Demiryürek H, Yag˘mur Ö. Percutaneous self-expandable uncovered metallic stents in malignant biliary obstruction: complications, follow-up and reintervention in 154 patients. Acta Radiol. 2003;44(2):139–46. doi: 10.1080/02841850360517919 . Mazza E, Carmignani L, Stecco A, Lucibello P. Interventional radiology in the palliative treatment of pancreatic cancer. Tumori. 1999;85(1 Suppl 1):S54-9. Schmassmann A, Van Gunten E, Knuchel J, Scheurer U, Fehr HF, Halter F. Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival. Am J Gastroenterol. 1996;91(4):761–5. Ball T, Connors P, Cotton P, Geenen J, Hawes R, Jowell P, et al. Multicenter, randomized trial of Wallstent biliary endoprosthesis versus plastic stents. Gastrointest Endosc. 1993;39(4):372–8. Kaassis M, Boyer J, Dumas R, Ponchon T, Coumaros D, Delcenserie R, et al. Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. Gastrointest Endosc. 2003;57(2):178–82. doi: 10.1067/mge.2003.60 . George C, Byass OR, Cast JEI. Interventional radiology in the management of malignant biliary obstruction. World J Gastrointest Oncol. 2010;2(3):146–50. doi: 10.4251/wjgo.v2.i3.146 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6486067","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":454754585,"identity":"349a1ea1-2b96-4acc-a0d9-59a8bbe57dfb","order_by":0,"name":"Ahmed Reda Elneanaey","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDUlEQVRIie2RMUsDMRTHXzjoZNv15VsUCqHgcf0gLgkHdamCCOLQIaWQLmJXv0Shk6uRg07xbj3pYr/BjR1EfFccHEx7o9D8CCEJ78f/hQcQCPxH7H4fAHQ1sApiurCpbaAgLQsRwqhWdEMFJMAZZL8ePXQ2ltq5x+suvL1W3BTJcp5RyiS+8Ck8l9SOw1s+e0zxxmzSZ6dIWY+utEfpOeqKGVQr63rISRGWFKazQ0q0Y1+oXuy4v2ubPBXF9qjSQqYpBcYC28YmojySwh0zA7lG9VQ6cY55KkVJKfLAXzouyspqEqvF4qH/Xt0lQ1Fcbj/oxavUg6sn8nNugdpXSk/xH3zCsHlxIBAInArfRJ9kZ/gZUHkAAAAASUVORK5CYII=","orcid":"","institution":"Tanta Cancer Institute, Specialized Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Ahmed","middleName":"Reda","lastName":"Elneanaey","suffix":""},{"id":454754587,"identity":"476fcac1-b7b7-4b48-a782-53628f749c0c","order_by":1,"name":"Ahmed Said Saafan","email":"","orcid":"","institution":"Tanta Cancer Institute, Specialized Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"Said","lastName":"Saafan","suffix":""},{"id":454754590,"identity":"64c16c85-3c59-4622-9b97-55f651df607d","order_by":2,"name":"Inas Mohammed Sweed","email":"","orcid":"","institution":"Banha University","correspondingAuthor":false,"prefix":"","firstName":"Inas","middleName":"Mohammed","lastName":"Sweed","suffix":""},{"id":454754592,"identity":"58a0d928-b585-4073-85c2-dc9958fd335b","order_by":3,"name":"Hesham El-Sayed El-Sheikh","email":"","orcid":"","institution":"Banha University","correspondingAuthor":false,"prefix":"","firstName":"Hesham","middleName":"El-Sayed","lastName":"El-Sheikh","suffix":""},{"id":454754594,"identity":"644a18fd-f634-45f5-9caa-4c8b7a47e72e","order_by":4,"name":"Eman Fathy Abdelkhalik","email":"","orcid":"","institution":"Banha University","correspondingAuthor":false,"prefix":"","firstName":"Eman","middleName":"Fathy","lastName":"Abdelkhalik","suffix":""}],"badges":[],"createdAt":"2025-04-19 17:23:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6486067/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6486067/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82713136,"identity":"a46d0d5c-0141-4364-b235-decf452e8067","added_by":"auto","created_at":"2025-05-14 11:49:48","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":190037,"visible":true,"origin":"","legend":"\u003cp\u003eUltrasound showed dilated CBD caliber reaching 11mm (arrow) with no detectable masses or stones inside its lumen. (B): PTC showed dilated IHBR and CBD till a tight obstructing stricture is seen (arrow). (C): A guide wire succeeded to cross the stricture into the duodenum (arrow). (D): A catheter passed through the stricture over the guide wire (arrow). (E): Inserted internal –external pigtail catheter with free contrast flow into the duodenum (arrow)\u003c/p\u003e","description":"","filename":"Figure1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6486067/v1/2fc8065b08993dda8122af4f.jpeg"},{"id":82713135,"identity":"953ed548-d0dd-4a53-ae41-4941db74f41e","added_by":"auto","created_at":"2025-05-14 11:49:48","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":41444,"visible":true,"origin":"","legend":"\u003cp\u003e(A): PTC thought percutaneous drainage tube showing distal CBD stricture (arrow) with mild proximal dilation. (B): A guide wire passing through the stricture into the duodenum (arrow). (C): A metallic stent was inserted in its place across the stricture (arrow). (D): Contrast injected via the external drain passed freely through the metallic stent to the duodenum (arrow)\u003c/p\u003e","description":"","filename":"Figure2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6486067/v1/a823910d63c7f67b192c5617.jpeg"},{"id":83726202,"identity":"9385ff45-3a48-4718-899b-868270cddebc","added_by":"auto","created_at":"2025-06-01 09:08:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1161236,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6486067/v1/b49795b7-6fa7-4cb7-9714-1e0fb9793c1b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Benefits of Intervention Radiology in Treatment of Neoplastic Obstructive Jaundice","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe biliary system is composed of organs and ducts, including the gallbladder, bile ducts, and supporting structures, that are responsible for the production and transportation of bile (1).\u003c/p\u003e \u003cp\u003eMany causes of biliary obstruction are identified, including gallstones, malignant obstruction by the pancreas, common bile ducts (CBD), and hepatic tumours. Additionally, biliary obstruction may result from inflammation of the bile ducts (2,3).\u003c/p\u003e \u003cp\u003eJaundice is frequently caused by cancerous obstruction of the biliary tract. Primary pancreatobiliary tract cancers and other localised cancers The biliary tract is compressed by liver, gallbladder, duodenal, ampullary, and metastatic cancers, as well as regional malignant lymphadenopathy, resulting in the diagnosis of 80,000 new cancer cases annually (4).\u003c/p\u003e \u003cp\u003eThere are numerous diagnostic tools available; Some are non-invasive, such as Magnetic Resonance Cholangiopancreatography (MRCP) and ultrasonography. Invasive procedures, including Endoscopic Retrograde Cholangiopancreatography (ERCP) and Percutaneous Transhepatic Cholangiography (PTC), are prescribed for therapeutic purposes (5).\u003c/p\u003e \u003cp\u003eJaundice is frequently caused by malignant biliary tract obstruction. Primary pancreatobiliary tract cancers and other localised cancers The biliary tract is compressed by liver, gallbladder, duodenal, ampullary, and metastatic cancers, as well as regional malignant lymphadenopathy, resulting in the diagnosis of 80,000 new cancer cases annually (5).\u003c/p\u003e \u003cp\u003ePTC at recent history is used as therapeutic technique by placing self-expanding stents (metallic or plastic types) crossing malignant biliary strictures to enable palliative drainage. In comparison to ERCP, this percutaneous technique is less invasive and has the potential to supplant it (6,7,8).\u003c/p\u003e \u003cp\u003eThe objective of this investigation was to ascertain the advantages of intervention radiology in the management of neoplastic obstructive jaundice.\u003c/p\u003e "},{"header":"Patients and Methods","content":"\u003cp\u003eThis Interventional \u0026ldquo;Quasi\u0026rdquo; study was conducted on 30 patients aged from 37 to 75 old, both sexes, with malignant obstructive jaundice who underwent different modalities of intervention radiological intervention (PTD and biliary stenting), with failed ERCP, Refused surgical procedures and inoperable patients with irresectable tumours, malignant obstructive jaundice, and cardiac or renal impairment.\u003c/p\u003e \u003cp\u003eAn informed written consent was obtained from the patient. The study was done after approval from the Ethical Committee Radiology Department, Benha University Hospitals from June 2023 to June 2024.\u003c/p\u003e \u003cp\u003eExclusion criteria were patients who declined to participate in the study due to haemorrhage and coagulation profile disorders, as well as pregnancy as a consequence of radiation exposure.\u003c/p\u003e \u003cp\u003eAll patients were subjected to: history taking [Age and complaint (yellowish discolouration of the epidermis and sclera manifests as dark urine, abdominal pain, abdominal enlargement, fever, and rigours), a history of operations, primary tumour, and prior biliary interventions, general examination [fever, cachexia, and anemia], local abdominal examination (Laboratory evaluation of hepatomegaly, splenomegaly, ascites, abdominal structures, and palpable gallbladder [serum bilirubin, both total and direct, Prothrombin time and concentration, serum liver enzymes, including serum glutamic pyruvic transaminase (SGPT) and serum glutamic oxaloacetic transaminase (SGOT), and alkaline phosphatase], and radiological assessment: [A recent abdominal ultrasound, triphasic Computed Tomography study, MRCP (not applicable to all), and direct cholangiography are all required prior to percutaneous drainage].\u003c/p\u003e\n\u003ch3\u003ePre-procedures preparation:\u003c/h3\u003e\n\u003cp\u003eParticularly prior to biliary drainage procedures, the coagulation profile was assessed. The platelet count was at least 80.000/mm3, and the prothrombin time was verified to be within permissible limits (no more than 4 seconds longer than the control). If necessary, Platelets, fresh frozen plasma, and vitamin K were administered to address the deficiencies. The procedures were conveyed to the patient or patient relatives in accordance with their condition, and patients were instructed to fast for 6\u0026ndash;8 hours. The patient or their relatives executed informed assent. An intravenous cannula was implanted, aseptic conditions were verified, A pulse oximeter was accessible for patient monitoring, and an oxygen supply was readily available.\u003c/p\u003e \u003cp\u003ePatients who are preparing for biliary drainage: One hour prior to the procedure, prophylactic broad-spectrum antibiotics were administered, and an intravenous fluid infusion was initiated promptly and maintained throughout the procedure, and the vital signs for the patients are measured before the procedure and checked always during the procedure to confirming the continuous liability of the patient during whole procedure.\u003c/p\u003e \u003cp\u003ePercutaneous Transhepatic Cholangiography (PTC): The available imaging data were thoroughly reviewed before the procedure to confirm the degree and distribution of bile duct dilatation, prothrombin time was not exceeding 16 seconds, And in order to confirm the diagnosis and as a preliminary step prior to percutaneous interventional techniques, the prothrombin concentration was greater than 75% for all patients. antibiotics that are administered as a preventative; Injection of Ampicillin 1 gm and gentamicin 80 mg one hour before the procedure, followed by oral, antibiotic, ciprofloxacin or cephalosporins for two days, if there are signs of biliary infection, antibiotics were given according to culture and sensitivity test, the patient lie supine on X- ray table \u0026amp; prepared with antiseptic and surgical dressing, local anesthetic agent as Xylocaine 10 ml (Lidocaine hydrochloride 20 mg/ ml) was injected into the lower right intercostal muscles and under the subjacent liver capsule. With the respiration suspended, a 18 gauge sheathed needle is advanced under US guidance assisted into the dilated biliary radicles till its tip was visualized within the dilated radicle. Bile is aspirated after a duct has been perforated, and diluted contrast (Urographin 76%) is injected. Subsequently, images are acquired.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInterventional Radiological Techniques:\u003c/h2\u003e \u003cp\u003eThe obstructed biliary system was drained through percutaneous external biliary drainage. Femoral catheters (6\u0026ndash;8 F) and pigtail catheters (8\u0026ndash;12 F) were implemented. The outer sheath of the puncture needle was penetrated by a 0.035-inch guide wire in accordance with PTC. The biliary manipulation catheter (straight or Cobra catheter) was subsequently used to substitute the outer membrane. Subsequently, trials were conducted to circumvent the restriction. An internal-external biliary catheter or biliary endoprosthesis was inserted if the stricture was breached. If it was not, An external drainage catheter was affixed to the epidermis by sutures and positioned above the stricture.\u003c/p\u003e \u003cp\u003eBefore the endoprosthesis was inserted, the external drainage was performed as a preoperative decompression. The procedure was not completed due to the stricture not being bypassed, a lack of financial support, or the patients' refusal to undergo the procedure. In the event of duodenal infiltration, Percutaneous Internal-External Biliary Drainage was implemented to internally evacuate patients, which was a contraindication for endoprosthesis, or if the patient was unable to tolerate the high risk of bleeding or the dilatation of the liver track to a large size to be suitable for stent calibre. Pigtail catheters (with a diameter of 10 and 12 F) were implemented. After bypassing the stricture, the internal external drainage catheter was advanced over the guide wire so that its distal end was in the duodenum distal to the obstruction, and the proximal holes were in the biliary system above the stricture but not in the liver parenchyma. A cholangiogram was performed to confirm is position. The catheter was subsequently sealed and secured to the skin's surface with sutures.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEndoprosthesis\u003c/h3\u003e\n\u003cp\u003eMetallic: The 5F catheter is employed to navigate the stricture over it when GW is able to bypass the obstruction in these patients. Several balloon dilatations were performed on strictured segments using a 3 cm balloon with an 8 mm diameter and a 4 cm balloon with a 10 mm diameter catheter. The memotherm self-expandable stent was initially introduced along the strictured segment. Further balloon expansion of the stents after insertion was done to accelerate their self-expansion using 10 mm balloon in three cases. Good flow of the contrast was insured.\u003c/p\u003e \u003cp\u003ePlastic: Serial dilators were used to dilate the tract to the stent's diameter in these patients. A dilator of the same calibre as the stent was employed to ensure that the stent's proximal end was above the obstruction and its distal end was below it. The GW and inner 7\u0026ndash;8 F catheter of the stiffener were covered with a plastic stent. The GW and pusher were subsequently removed, and the inner 7 F catheter was pulled above the stent. A control contrast examination was conducted to confirm the stent's position and patency.\u003c/p\u003e \u003cp\u003eWhen it was difficult to cannulate with ERCP and the GW passed through the obstructed segment percutaneously, the Combined Endoscopic \u0026amp; Percutaneous Drainage Technique (Randez-Vous) was employed. The patient was placed supine, puncture then intubation of the biliary tract was done using a sheathed needle, manipulations by a torquable GW were done till crossing of the obstruction occurs, the GW was passed through the obstructed level and also fixed distally to the skin, The endoscope was inserted into the duodenum after the patient was situated in a prone position (anterior oblique position).\u003c/p\u003e \u003cp\u003eEndoscopic role: Placing a plastic endoprosthesis (10 F) was achieved by engaging the wire with a snare or receptacle and withdrawing it through the endoscope.\u003c/p\u003e\n\u003ch3\u003ePost-drainage care:\u003c/h3\u003e\n\u003cp\u003ePatients who have either external or internal-external drainage are required to remain in bed for 24 hours, continue to take antibiotics for 2 days following the procedure, flush the catheter daily with sterile saline, and undertake cholangiography three days following the procedure when the biliary flow is visibly reduced.\u003c/p\u003e \u003cp\u003eThe subsequent parameters were examined: The frequency of complications, the laboratory response to drainage and the clinical response to drainage.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eSPSS v28 (IBM Inc., Armonk, NY, USA) was employed to conduct the statistical analysis. The Shapiro-Wilks test and histograms were employed to evaluate the normality of the data distribution. The mean and standard deviation (SD) were presented as the result of the quantitative parametric data analysis using a paired t-test. Qualitative data were represented using frequency and percentage (%).A two-tailed P value of 0.05 or less was used to define statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e demonstrates that the age of the patients under investigation ranged from 44 to 80 years, with a mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation of 65.53\u0026thinsp;\u0026plusmn;\u0026thinsp;10.37 years. There were 14 (46.67%) males and 16 (53.33%) females. Regarding the abdominal examination, 13 (43.33%) patients had hepatomegaly, 1 (3.33%) patient had splenomegaly, 12 (40%) patients had ascites, 15 (50%) patients had abdominal masses, and 18 (60%) patients had palpable gallbladder. Total bilirubin was with a mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of 8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.48 mg/dL. Direct bilirubin was with a mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of 7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.25 mg/dL.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic data, abdominal examination, and laboratory data of the studied patients (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePatients (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.53\u0026thinsp;\u0026plusmn;\u0026thinsp;10.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (46.67%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (53.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eAbdominal examination\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHepatomegaly\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (43.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSplenomegaly\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (3.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAscites\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (40%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAbdominal masses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (50%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePalpable gallbladder\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (60%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eLaboratory investigation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal bilirubin (mg/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDirect bilirubin (mg/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or frequency (%)\u003c/p\u003e \u003cp\u003eRegarding the previous operations, 4 (13.33%) patients underwent cholecystectomy, 1 (3.33%) patient underwent hemicolectomy, 3 (10%) patients underwent ERCP, 1 (3.33%) patient underwent Rendez vous procedure, 4 (13.33%) patients underwent Whipple operation, and 2 (6.67%) patients underwent breast surgeries. Regarding the previous biliary interventions, 1 (3.33%) patient underwent cholecystectomy, 1 (3.33%) patient underwent biliary stent, 2 (6.67%) patients underwent ERCP, 1 (3.33%) patient underwent ERCP with biliary stent, 1 (3.33%) patient underwent hepatobiliary anastomosis, and 1 (3.33%) patient underwent Rendez vous procedure. Regarding the type of tumor, 9 (30%) patients had cholangiocarcinoma, 2 (6.67%) patients had colorectal tumor, 10 (33.33%) patients had pancreatic mass, 1 (3.33%) patient had duodenal mass, 2 (6.67%) patients had ampullary mass, 3 (10%) patients had GB mass, and 3 (10%) patients had breast cancer. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHistory of previous operations and biliary interventions, and type of tumor of the studied patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003ePrevious operations\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCholecystectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (13.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHemicolectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (3.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eERCP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (10%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRendez vous procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (3.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhipple operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (13.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBreast surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (6.67%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003ePrevious biliary interventions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCholecystectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (3.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBiliary stent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (3.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eERCP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (6.67%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eERCP with biliary stent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (3.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHepatobiliary anastomosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (3.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRendez vous procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (3.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e\u003cb\u003eType of tumor\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCholangiocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (30%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eColorectal tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (6.67%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePancreatic mass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (33.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuodenal mass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (3.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmpullary mass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (6.67%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGB mass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (10%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBreast cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (10%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData are presented as frequency (%). ERCP: Endoscopic Retrograde Cholangiopancreatography\u003c/p\u003e \u003cp\u003eRegarding the interventional techniques, 28 (93.33%) Patients underwent both internal and external biliary drainage, One patient (3.33%) underwent internal and external biliary drainage, followed by the insertion of a metallic stent in the CBD and two additional metallic stents in the right and left hepatic ducts. Additionally, one patient (3.33%) underwent external biliary drainage, followed by internal and external biliary drainage. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInterventional techniques of the studied patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInternal \u0026amp; external biliary drainage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28 (93.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInternal \u0026amp; external biliary drainage then metallic stent\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (3.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExternal biliary drainage then internal \u0026amp; external biliary drainage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (3.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData are presented as frequency (%).\u003c/p\u003e \u003cp\u003eThe mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of total bilirubin was 1.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2 mg/dL 15 days after the intervention. The total bilirubin level was significantly lower after the intervention than it was prior to the intervention (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of total bilirubin before and after intervention (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore intervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 days after intervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal bilirubin (mg/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD *: significant as P value\u0026thinsp;\u0026lt;\u0026thinsp;0.005.\u003c/p\u003e \u003cp\u003eRegarding the complications 7 (23.33%) patients developed biliary hemorrhage, and 1 (3.33%) patient was blocked and upsized. Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComplications of the studied patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBiliary hemorrhage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (23.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBlocked and upsized\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (3.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData are presented as frequency (%).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eCase presentation\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eCase 1:\u003c/h2\u003e \u003cp\u003eClinical data: Male patient A 64-year-old individual was diagnosed with periampullary carcinoma through laboratory testing: The total bilirubin level was 8 mg/dL at the time of the procedure, and it was 1.8 mg/dL after 15 days. Additionally, internal-external drainage was implemented Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eCase 2:\u003c/h3\u003e\n\u003cp\u003eClinical data: Female patient aged 67-years-old diagnosed to have cancer head pancreas, laboratory: Total bilirubin level reaches 6.5mg/dl., and total bilirubin level after 15 day 1.4mg/dl, and procedure: Percutaneous metallic stent was inserted in two steps after external biliary drainage. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe gallbladder, bile ducts, and supporting structures are among the organs and ducts that compose the biliary system, which is accountable for the production and transportation of bile. The gallbladder, bile ducts, and supporting structures are among the organs and ducts that compose the biliary system, which is responsible for the production and transportation of bile \u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eRegarding the type of tumor, 9 (30%) patients had cholangiocarcinoma, 2 (6.67%) patients had colorectal tumor, 10 (33.33%) patients had pancreatic mass, 1 (3.33%) patient had duodenal mass, 2 (6.67%) patients had ampullary mass, 3 (10%) patients had GB mass, and 3 (10%) patients had breast cancer.\u003c/p\u003e \u003cp\u003e \u003cb\u003eHazem et al.\u003c/b\u003e It was discovered that 12 patients had been diagnosed with pancreatic head cancer, which accounted for 40% of the patients. Additionally, Cholangicarcinoma (central and peripheral varieties) was diagnosed in 8 patients, representing 26.6% of the total. Four patients were diagnosed with periampullary carcinoma, which accounted for 13.3% of the patients. Four patients were diagnosed with an enlarged porta hepatis lymph node, which accounted for 13.3% of the patients. The final two patients were diagnosed with hepatic metastasis \u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eRegarding the previous biliary interventions, 1 (3.33%) patient underwent cholecystectomy, 1 (3.33%) patient underwent biliary stent, 2 (6.67%) patients underwent ERCP, 1 (3.33%) patient underwent ERCP with biliary stent, 1 (3.33%) patient underwent hepatobiliary anastomosis and 1 (3.33%) patient underwent Rendez vous procedure.\u003c/p\u003e \u003cp\u003e \u003cb\u003eHazem et al.\u003c/b\u003e According to the findings, limited biliary dilatation was observed in approximately three patients (10%), mild dilatation in five patients (16.7%), moderate dilatation in thirteen patients (43.3%), and marked dilatation in the final nine patients (30%). Our study group was composed of 2 patients at the intrahepatic level (6.7%), 8 patients at the porta hepatis level (26.7%), 2 patients at the proximal CBD level (6.7%), 14 patients at the distal CBD level (46.6%), and the final 4 patients at the periampullary level (13.3%), categorised according to the degree of biliary obstruction \u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eRegarding the abdominal examination, 13 (43.33%) patients had hepatomegaly, 1 (3.33%) patient had splenomegaly, 12 (40%) patients had ascites, 15 (50%) patients had abdominal masses, and 18 (60%) patients had palpable gallbladder.\u003c/p\u003e \u003cp\u003eIn Wong review, Specific predictors of a probable poor prognosis following biliary stenting were identified in 90 stent deployments in 76 patients (male: female\u0026thinsp;=\u0026thinsp;40: 36; age range\u0026thinsp;=\u0026thinsp;43 to 94 years) with malignant biliary strictures. Ampullary carcinoma (6.6%), pancreatic carcinoma (55.3%), metastatic carcinoma (18.4%), cholangiocarcinoma (11.8%), and other causes (7.9%) (128) were the causes of malignant biliary obstruction.\u003c/p\u003e \u003cp\u003eIn the present study, it was determined that the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of total bilirubin was 8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.48 mg/dL, with a range of 5.2 to 15.4 mg/dL. Direct bilirubin ranged from 4.6 to 13.5 mg/dL with a mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of 7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.25 mg/dL. Total bilirubin was significantly decreased after intervention than before intervention (P value\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cb\u003eAbdelghafar Salim\u003c/b\u003e et al. highlighted that during Laboratory investigation was conducted to monitor the patients' total bilirubin levels following the procedure. The therapeutic efficacy was determined by the 15-day total bilirubin level. Metallic stenting obtained the lowest mean total bilirubin level (3.8 mg/ml) among the various groups in this study, The mean total bilirubin level was at its highest (10 mg/dl) 15 days after percutaneous external drainage \u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis can be partially attributed to the high flow rates and wide calibre of metallic stents, as well as the fact that a significant number of patients who underwent external drainage presented with liver cirrhosis or metastasis, which increased the mean post-drainage bilirubin.\u003c/p\u003e \u003cp\u003eRegarding the interventional techniques, 28 (93.33%) patients underwent internal \u0026amp; external biliary drainage, 1 (3.33%) The patient underwent internal and external biliary drainage, followed by the insertion of a metallic stent in the CBD and two additional metallic stents in the right and left hepatic ducts. Additionally, one patient (3.33%) underwent external biliary drainage, followed by internal and external biliary drainage.\u003c/p\u003e \u003cp\u003eFor more than four decades, percutaneous biliary drainage procedures have been implemented, with modifications and enhancements to the techniques.\u003c/p\u003e \u003cp\u003e \u003cb\u003eHazem et al.\u003c/b\u003e revealed that metallic stenting demonstrated a high success rate in reducing bilirubin levels and their associated complications in patients who were suitable for operation (Whipple) and had a postoperative biliary stricture resulting from choledocho-jujenostomy \u003csup\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThere was a technical success rate of 13/15 (81.2%) for percutaneous stricture crossing and stenting. This outcome surpasses that reported in the investigation Pinol et al., which achieved a technical success rate of 75% for percutaneous metallic stenting \u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e. On the other hand, \u003cb\u003eSchoder et al.\u003c/b\u003e, and \u003cb\u003eInal et al\u003c/b\u003e. The technical success rate for percutaneous metallic stenting was reported to be 100%. This discrepancy may be attributed to the degree of rigidity of biliary obstruction and tumour infiltration, as well as the variability of personal experience \u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMetallic stents demonstrated substantial clinical advantages over plastic stents. Metallic stents with a broader calibre experience fewer occlusions. Therefore, Despite its higher initial cost, the metallic stent offers a cost-benefit advantage as a result of the reduced need for subsequent intervention.\u003c/p\u003e \u003cp\u003eThis same conclusion has been reached by a multitude of investigators, including \u003cb\u003eCarr-Locke et al., Schmassmann et al., and Kaassis et al.\u003c/b\u003e, Metallic stents are advantageous over plastic stents solely when it is anticipated that the patient will endure for an extended period of time (e.g., six months) \u003csup\u003e\u003cb\u003e(14\u0026ndash; \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eRegarding the complications, 7 (23.33%) patients developed biliary hemorrhage, and 1 (3.33%) patient was blocked and upsized.\u003c/p\u003e \u003cp\u003e \u003cb\u003eGeorge et al.\u003c/b\u003e It was emphasised that the biliary tract stenting and drainage procedure is a safe procedure; however, it does have risks, which can be categorised as immediate and late complications. Pain at the puncture site, bile escape, intrahepatic and extrahepatic haemorrhage, including haemobilia, pneumothorax, haemothorax, septicaemia, and catheter-related issues such as kinking or dislocation, are all potential immediate complications. The left lobe punctures may be less unpleasant for patients, as they do not traverse the intercostal space. Nevertheless, the reduced liver's ability to tamponade the puncture canal may result in a higher incidence of bile leak or haemorrhage. Moderate to severe bile haemorrhage and bleeding may induce pain secondary to peritonitis, particularly referred pain at the shoulder tip. Traversing the pleura may lead to pneumothorax and haemothorax, which are uncommon. Among the late complications are cholangitis, pancreatitis, septicaemia, liver abscess, obstruction of drainage catheter or stent, and arterial or venous biliary fistula. Stent occlusion may be the consequence of tumour ingrowth or biliary sediment or calculi \u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAbdelghafar Salim et al.\u003c/b\u003e revealed that the percutaneous drainage group experienced the highest rate of complications, with hemobilia being the most frequently occurring complication in the study \u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e. \u003cb\u003eHazem et al.\u003c/b\u003e Hemobillia, subcapular leakage, dislodgment, stent occlusion, and cholangitis were the most frequently occurring complications \u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWe recommend that: Provide larger sample size with multicenter cooperation to validate our results; further research is required to generalize our results and well mention it; interventional radiology may have a pro.\u003c/p\u003e \u003cp\u003eLimitations: The sample size was relatively modest. There was only one centre where the investigation was conducted.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eInterventional radiology provides significant symptomatic relief to patients with malignant biliary obstruction, thereby improving their quality of life.\u003c/p\u003e"},{"header":"Abbreviations","content":" \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAbbreviation\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eFull Term\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCBD\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eCommon Bile Duct\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCT\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eComputed Tomography\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eERCP\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eEndoscopic Retrograde Cholangiopancreatography\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eGB\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eGallbladder\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eGW\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eGuide Wire\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMRCP\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eMagnetic Resonance Cholangiopancreatography\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePTC\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003ePercutaneous Transhepatic Cholangiography\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePTD\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003ePercutaneous Transhepatic Drainage\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSGOT\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSerum Glutamic Oxaloacetic Transaminase\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSGPT\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSerum Glutamic Pyruvic Transaminase\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt was approved by the ethics committee of Radiology Department, Benha University Hospitals and it was started at June 2023 to June 2024. An informed written consent was obtained from the participants. \u0026nbsp;approval No. MD 10-3-2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: All authors give their consent for publication in the journal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material:\u0026nbsp;\u003c/strong\u003eData and material are available on a reasonable request from the author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: The authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNil.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e ARE and ASS conceived and supervised the study; IMS and HEE were responsible for data collection. EFA and ARE analysed and interpreted the data. All authors provided comments on the manuscript at various stages of development. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e Nil\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e Nil\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDawoud AM, Omar HM, Amin MA, Nooman A. Radiological intervention and imaging procedures in management of patients with malignant obstructive jaundice. Med J Cairo Univ. 2019;87(5):2791\u0026ndash;800.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFekaj E, Jankulovski N, Matveeva N. Obstructive jaundice. Austin Dig Syst. 2017;2(1):1006.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRees J, Mytton J, Evison F, Mangat KS, Patel P, Trudgill N. The outcomes of biliary drainage by percutaneous transhepatic cholangiography for the palliation of malignant biliary obstruction in England between 2001 and 2014: a retrospective cohort study. BMJ Open. 2020;10(1):33\u0026ndash;76. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjopen-2019-033076\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2019-033076\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShukla S, Kharat PR, Patbamniya N, Kumar K. Clinicopathological study on patients presenting with obstructive jaundice. Int Surg J. 2018;5(2):705\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarth KH. Percutaneous biliary drainage for high obstruction. Radiol Clin North Am. 1990;28(6):1223\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl Mahjoub A, Menahem B, Fohlen A, Dupont B, Alves A, Launoy G, et al. Preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma: is percutaneous transhepatic biliary drainage safer and more effective than endoscopic biliary drainage? A meta-analysis. J Vasc Interv Radiol. 2017;28(4):576\u0026ndash;82. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jvir.2016.12.1220\u003c/span\u003e\u003cspan address=\"10.1016/j.jvir.2016.12.1220\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang L, Lin N, Xin F, Ke Q, Zeng Y, Liu J. A systematic review of the comparison of the incidence of seeding metastasis between endoscopic biliary drainage and percutaneous transhepatic biliary drainage for resectable malignant biliary obstruction. World J Surg Oncol. 2019;17:116. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12957-019-1668-7\u003c/span\u003e\u003cspan address=\"10.1186/s12957-019-1668-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerquist TH, May GR, Johnson CM, Adson MA, Thistle JL. Percutaneous biliary decompression: internal and external drainage in 50 patients. AJR Am J Roentgenol. 1981;136(5):901\u0026ndash;6. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2214/ajr.136.5.901\u003c/span\u003e\u003cspan address=\"10.2214/ajr.136.5.901\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalim MA, Elfeshawy MS, Elziat TM. Radiological interventional and imaging procedures in management of patient with malignant obstructive jaundice. Al-Azhar Int Med J. 2022;3(11):154\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHazem M, Ashraf MD, Nooman MA, Mohammed A. Radiological intervention and imaging procedures in management of patients with malignant obstructive jaundice. Med J Cairo Univ. 2019;87(9):2791\u0026ndash;800.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchoder M, Rossi P, Uflacker R, Bezzi M, Stadler A, Funovics MA, et al. Malignant biliary obstruction: treatment with ePTFE-FEP\u0026ndash;covered endoprostheses\u0026mdash;initial technical and clinical experiences in a multicenter trial. Radiology. 2002;225(1):35\u0026ndash;42. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1148/radiol.2251010992\u003c/span\u003e\u003cspan address=\"10.1148/radiol.2251010992\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eİnal M, Akg\u0026uuml;l E, Aksungur E, Demiry\u0026uuml;rek H, Yag˘mur \u0026Ouml;. Percutaneous self-expandable uncovered metallic stents in malignant biliary obstruction: complications, follow-up and reintervention in 154 patients. Acta Radiol. 2003;44(2):139\u0026ndash;46. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/02841850360517919\u003c/span\u003e\u003cspan address=\"10.1080/02841850360517919\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMazza E, Carmignani L, Stecco A, Lucibello P. Interventional radiology in the palliative treatment of pancreatic cancer. Tumori. 1999;85(1 Suppl 1):S54-9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchmassmann A, Van Gunten E, Knuchel J, Scheurer U, Fehr HF, Halter F. Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival. Am J Gastroenterol. 1996;91(4):761\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBall T, Connors P, Cotton P, Geenen J, Hawes R, Jowell P, et al. Multicenter, randomized trial of Wallstent biliary endoprosthesis versus plastic stents. Gastrointest Endosc. 1993;39(4):372\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaassis M, Boyer J, Dumas R, Ponchon T, Coumaros D, Delcenserie R, et al. Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. Gastrointest Endosc. 2003;57(2):178\u0026ndash;82. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1067/mge.2003.60\u003c/span\u003e\u003cspan address=\"10.1067/mge.2003.60\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeorge C, Byass OR, Cast JEI. Interventional radiology in the management of malignant biliary obstruction. World J Gastrointest Oncol. 2010;2(3):146\u0026ndash;50. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4251/wjgo.v2.i3.146\u003c/span\u003e\u003cspan address=\"10.4251/wjgo.v2.i3.146\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Intervention Radiology, Neoplastic Obstructive Jaundice, Biliary tract obstruction, Percutaneous Transhepatic Cholangiography","lastPublishedDoi":"10.21203/rs.3.rs-6486067/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6486067/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eJaundice is frequently caused by malignant biliary tract obstruction. Many tools can be used in diagnosis; some of them are non-invasive while others are invasive. PTC at recent history is used as therapeutic technique. The objective of the investigation was to identify the advantages of intervention radiology in the management of neoplastic obstructive jaundice.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis was an interventional study was conducted on 30 patients aged from 37 to 75 old, both sexes, with malignant obstructive jaundice. History-taking was implemented for each patient, clinical Examination [general, and local abdominal examination], radiological investigation [abdominal ultrasound, and triphasic CT, and direct cholangiography], and laboratory assessment [serum bilirubin, serum alkaline phosphatase, serum liver enzymes, including serum glutamic pyruvic transaminase and serum glutamic oxaloacetic transaminase, and prothrombin time and concentration, both total and direct].\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eTotal bilirubin was significantly decreased after intervention than before intervention (P value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Regarding the interventional techniques, 28 (93.33%) Patients underwent both internal and external biliary drainage, 1 (3.33%) patient underwent internal \u0026amp; An external biliary drainage was performed on one patient (3.33%), Subsequently, a metallic stent is inserted into the common bile duct, and two additional metallic stents are inserted into the right and left hepatic ducts. Furthermore, one patient underwent both internal and external biliary drainage.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eInterventional radiology provides significant symptomatic relief to patients with malignant biliary obstruction, thereby enhancing their quality of life.\u003c/p\u003e","manuscriptTitle":"The Benefits of Intervention Radiology in Treatment of Neoplastic Obstructive Jaundice","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-14 11:49:43","doi":"10.21203/rs.3.rs-6486067/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a26ee7cc-bcea-4bf4-ac73-914938cb1852","owner":[],"postedDate":"May 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-01T09:08:12+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-14 11:49:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6486067","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6486067","identity":"rs-6486067","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}