SIR ePoster Library

Comparison of Long-term Outcomes Before and After the Implementation of a Structured Benign Biliary Anastomotic Stricture Treatment Protocol
SIR ePoster library. Lindquester W. 03/04/17; 169947; 511
Will Lindquester
Will Lindquester
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Abstract
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Final ID
511

Type
Original Scientific Research-Oral or Pos

Authors
W Lindquester1, J Prologo2, E Krupinski3, G Peters4

Institutions
1Emory University SOM, Atlanta, GA, 2Emory University School of Medicine, Division of Interventional Radiology and Image Guided Medicine, Atlanta, GA, 3Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, Atlanta, GA, 4Emory University, Atlanta, GA

Purpose
To compare long-term outcomes before and after the implementation of a structured protocol for percutaneous drainage and management of benign post-surgical biliary strictures.

Materials & Methods
All adult patients receiving a percutaneous transhepatic cholangiogram (PTC) at our institution between 1994 and 2015 were identified using CPT billing codes. The medical records were retrospectively reviewed, and the incidence of surgical anastomotic revision was compared between patients treated before and after the implementation of a structured protocol. Patient characteristics and treatment variables (including maximum drain size, number of cholangioplasties, and use of a cutting balloon) were also analyzed with respect to the incidence of surgical revision. A Kaplan-Meier analysis was performed to determine the long-term probabilities of avoiding surgical revision.

Results
305 patients were identified. Of these, 234 underwent intervention prior to the implementation of a structured protocol, and 71 afterward. Overall, 72.8% of all patients avoided surgical revision, with 71.1% before the protocol was implemented and 81.7% after. Although there was no statistically significant difference in revision rates, males, older age at time of first tube, longer time from surgery to placement of the initial tube, and a larger maximum tube size were all associated with increased avoidance of surgical revision. Kaplan-Meier analysis demonstrated surgical avoidance for drains placed prior to the protocol was 78.2%, 76.5%, 69.1%, 65.5% and 63.3% at 1, 2, 5, 10, and 20 years respectively, and 85.2%, 80.8%, and 80.8% at 1, 2, and 5 years after the implementation of the protocol.

Conclusions
Percutaneous drainage and management of benign post-surgical biliary anastomotic strictures prevents surgical revision in a majority of cases regardless of the presence of a structured protocol. Although there is no statistically significant benefit in terms of avoidance of surgical revision before and after the implementation of the protocol, a structured protocol can postpone the need for surgery. Additionally, a larger maximum tube size is associated with a better outcome.

Final ID
511

Type
Original Scientific Research-Oral or Pos

Authors
W Lindquester1, J Prologo2, E Krupinski3, G Peters4

Institutions
1Emory University SOM, Atlanta, GA, 2Emory University School of Medicine, Division of Interventional Radiology and Image Guided Medicine, Atlanta, GA, 3Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, Atlanta, GA, 4Emory University, Atlanta, GA

Purpose
To compare long-term outcomes before and after the implementation of a structured protocol for percutaneous drainage and management of benign post-surgical biliary strictures.

Materials & Methods
All adult patients receiving a percutaneous transhepatic cholangiogram (PTC) at our institution between 1994 and 2015 were identified using CPT billing codes. The medical records were retrospectively reviewed, and the incidence of surgical anastomotic revision was compared between patients treated before and after the implementation of a structured protocol. Patient characteristics and treatment variables (including maximum drain size, number of cholangioplasties, and use of a cutting balloon) were also analyzed with respect to the incidence of surgical revision. A Kaplan-Meier analysis was performed to determine the long-term probabilities of avoiding surgical revision.

Results
305 patients were identified. Of these, 234 underwent intervention prior to the implementation of a structured protocol, and 71 afterward. Overall, 72.8% of all patients avoided surgical revision, with 71.1% before the protocol was implemented and 81.7% after. Although there was no statistically significant difference in revision rates, males, older age at time of first tube, longer time from surgery to placement of the initial tube, and a larger maximum tube size were all associated with increased avoidance of surgical revision. Kaplan-Meier analysis demonstrated surgical avoidance for drains placed prior to the protocol was 78.2%, 76.5%, 69.1%, 65.5% and 63.3% at 1, 2, 5, 10, and 20 years respectively, and 85.2%, 80.8%, and 80.8% at 1, 2, and 5 years after the implementation of the protocol.

Conclusions
Percutaneous drainage and management of benign post-surgical biliary anastomotic strictures prevents surgical revision in a majority of cases regardless of the presence of a structured protocol. Although there is no statistically significant benefit in terms of avoidance of surgical revision before and after the implementation of the protocol, a structured protocol can postpone the need for surgery. Additionally, a larger maximum tube size is associated with a better outcome.

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