E1522. Effect of Upsizing Percutaneous Biliary Drains to Improve Hyperbilirubinemia in the Setting of Malignant Distal Biliary Obstruction
  1. Ethan Davoudzadeh; Northwell Health
  2. Samir Yezdani; Northwell Health
  3. Eric Gandras; Northwell Health
  4. Craig Greben; Northwell Health
  5. Jonathan Weinstein; Northwell Health
Malignant distal biliary obstruction can cause hyperbilirubinemia that may result in symptoms and preclude certain chemotherapy regimens. Percutaneous biliary drainage is a therapy for patients with malignant obstructive jaundice to improve elevated bilirubin levels, usually in the setting of failed retrograde stenting. The purpose of this study is to determine whether there is a difference in bilirubin levels between biliary drains sized 14 French (Fr) and less vs 16 Fr or higher.

Materials and Methods:
A system wide search of the electronic medical record was performed for patients who received biliary drainage catheters that were subsequently upsized to 16 Fr or higher between January 1, 2018 to June 30, 2021, per referral request. Patients with elevated bilirubin levels > 1.2 mg/dL secondary to a malignant distal biliary obstruction were included. 6 patients were diagnosed with pancreatic head adenocarcinoma and 1 with hilar cholangiocarcinoma. These patients were not stented for various reasons including potential surgical resection. The referrers request to upsize was to improve persistent hyperbilirubinemia that was not alleviated by smaller tubes. Bilirubin levels were recorded 5 - 15 days after upsizing in all patients. The absolute and percent difference between bilirubin values of the 12/14 Fr drain versus 16 Fr or higher were measured.

7 patients meeting our criteria were identified. All patients demonstrated a negligible difference of bilirubin levels between the 12/14 Fr and 16 Fr or higher with an average percent difference ranging from a decrease of 3% to an increase of 6%, including 2 patients with no difference and 1 patient with a 6% increase in bilirubin levels.

Biliary drains are often utilized in patients with malignant distal biliary obstruction to relieve hyperbilirubinemia. In our small cohort of patients with biliary drainage catheters 16 Fr or higher, all patients had negligible difference in their bilirubin levels as compared to the 12/14 Fr drains. Given our findings suggesting a negligible difference in bilirubin values with upsized biliary drains and the associated risks, interventional radiologists should consider the efficacy of such a procedure. Further investigation with a larger cohort is warranted in patients who are not stenting candidates.