الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Percutaneous radiological interventional procedures proved to be a valuable option in management of either benign or malignant biliary obstruction. Many different techniques and management protocols had been described in literatures. These different procedures share in common that they are considered invasive techniques and pre- as well as post-procedure care must be taken to reduce complications. This study included 238 patients with biliary obstruction (malignant obstruction in 214 cases, benign obstruction in 24 cases), aiming to assess effectiveness and complications of different percutaneous interventional radiological procedures (PTBD, balloon dilatation &/or stent) in patients with biliary obstruction. In malignant cases, internal-external percutaneous transhepatic biliary drainage was used in 167 cases (80 %), external percutaneous transhepatic biliary drainage was used in cases 40 cases (18.2 %) and bilobar internal and external drainage tubes were used in 6 cases (2.8 %). Uncovered self-expandable metallic stents were used in 21 cases (9.8 %) and in-sent balloon dilatation was performed in 5 cases (2.3 %). In cases with benign obstruction (24 cases), technical success was achieved in 18 of 24 cases (75 %). Stricture couldn’t be dilated in 6 cases (25 %). These cases were managed surgically later on. In malignant biliary obstruction cases (214 cases), the chief presentation was jaundice (207 out of 214 cases, 96 %). Cholangitis was the dominant presentation in benign obstruction group (15 out of 24 cases, 62%). Post-procedure control of suppurative cholangitis was achieved, proved by improved general condition and laboratory markers (P-value 0.002). Statistical analysis had shown significant DROP in bilirubin values in both benign and malignant cases after the procedure (P-value ≤0.001). Statistical analysis also showed no significant difference between right and left lobe approaches regarding DROP of bilirubin levels and incidence of complications. A total of 165 complications were recorded during this study. Newly developed fever and cholangitis were the most common complication within the first three months post-procedure (65 cases, 27.3%) followed by catheter dislodgment, peri-catheter leak and bleeding (18.5%, 17.6% and 5.9% respectively). Increased incidence of post-procedural fever was noticed among cases with internal drainage group (32.8%) compared to external drain group (25.6%), however the difference was statistically insignificant. To conclude, percutaneous biliary interventional procedures are effective in reducing bilirubin levels as well as management of biliary stasis induced cholangitis in both benign and malignant biliary obstruction. These techniques can be performed by experienced operators, using current recommended practice guidelines with adequate safety and acceptable complications rate.