1482P - Percutaneous transhepatic biliary drainage (PTBD) for palliation of jaundice in patients of unresectable/disseminated carcinoma gall bladder with hilar block: Is it a worthwhile enterprise?

Background

More than 80% patients of Carcinoma Gall bladder (Ca GB) present with unresectable or disseminated disease. In these patients jaundice can be very distressing leading to poor quality of life (QOL) PTBD has been advocated to palliate this but, its impact on QOL has not been adequately studied.

Methods

Prospective observational study over two years included patients of proven unresectable/disseminated Ca GB presenting with jaundice. Pre-procedure parameters were recorded and PTBD done. Quality of Life (QOL) was assessed by EORTC QLQ-C30 and BIL-21 scores prior to the treatment and after 1- month. Post procedure complications were reported. Follow up was done at 1,3 and 6 months.

Results

Study included 43 patients of unresectable/disseminated Ca GB. Median age was 52 years with 74% females. 26 patients underwent unilateral (U/L) and 17 bilateral (B/L) PTBD. 4 patients needed B/L PTBD for inadequate bilirubin fall at 4 weeks. Mean serum bilirubin was 18.3 ± 7.3 mg/dl, albumin was 2.9 ± 0.5 mg/dl and INR was 1.7 ± 1.2. Commonest indication for PTBD was pruritus (65%) and only 12% patients had cholangitis. Bilirubin level at 1 week and 1 month was 15mg/dl and 7.1 mg/dl respectively(p=0.0002). Unfortunately, EORTC QLQ-C30 QOL scores showed decline in all aspects at 1 months and 3 months. Even in BIL-21 scores although there was improvement in Jaundice scale those with anxiety, pain and side effects had decline. Most patients had morbidity related to either slippage of PTBD or peri-tubal leakage. Also, inevitability of disease progression due to lack of treatment caused significant anxiety. 4 patients expired within 30 days due to cholangitis. Survival at 1-, 3- and 6- months was 60%, 23% and 7% respectively with median survival of 38 days.

Conclusions

Although jaundice is a fairly debilitating symptom in patients with unresectable Ca GB, palliation in form of PTBD may not always lead to improvement of QOL. Psychological counselling and proper guidance in terms of care of drains as well proper pain management is imperative to provide these terminally ill patients with best supportive care.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

S. Galodha.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.