Bleeding and vascular complications after percutaneous transhepatic biliary drainage: Incidence and associated factors in a Vietnamese tertiary center

doi:10.4240/wjgs.v18.i7.120929

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Publication Name

World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Jul 27, 2026; 18(7): 120929
Published online Jul 27, 2026. doi: 10.4240/wjgs.v18.i7.120929

Bleeding and vascular complications after percutaneous transhepatic biliary drainage: Incidence and associated factors in a Vietnamese tertiary center

Kim-Long Le, Thien Thuan Dinh, Khanh-Phat Thai, Tri-Nhan Pham, Minh-Quang Tran, Phu-Cuong Pham, My-Tran Trinh, Nhu Ngoc-Quynh Duong, Trong-Kha Nguyen, Nguyen-Khoi Le, Tuong-Anh Mai-Phan

Kim-Long Le, Thien Thuan Dinh, Khanh-Phat Thai, Trong-Kha Nguyen, Tuong-Anh Mai-Phan, Department of Hepato-Pancreato-Biliary Surgery, Nhan dan Gia Dinh Hospital, Ho Chi Minh City 07000, Viet Nam

Kim-Long Le, Tri-Nhan Pham, Minh-Quang Tran, Phu-Cuong Pham, My-Tran Trinh, Nguyen-Khoi Le, Department of Surgery, Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 07000, Viet Nam

Nhu Ngoc-Quynh Duong, Department of Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 07000, Viet Nam

Co-first authors: Kim-Long Le and Thien Thuan Dinh.

Co-corresponding authors: Nguyen-Khoi Le and Tuong-Anh Mai-Phan.

Author contributions: Le KL and Dinh TT conceived and coordinated the study, supervised the project, and they contributed equally to this manuscript as co-first authors; Mai-Phan TA and Thai KP contributed to study conceptualisation and design; Pham TN, Tran MQ, Pham PC, and Trinh MT performed data acquisition and data extraction; Duong NNQ, Dinh TT, and Nguyen TK contributed to data analysis, interpretation, and preparation of figures and tables; Le NK and Mai-Phan TA contributed equally to this manuscript as co-corresponding authors; Le NK, Le KL, and Mai-Phan TA performed critical revision, language editing, and final formatting. All authors read and approved the final manuscript.

AI contribution statement: During the preparation of this manuscript, the authors utilized ChatGPT Plus and Claude. These AI tools were used for language polishing, grammar, and spelling checks across most sections of the manuscript to enhance readability. Additionally, AI was utilized to assist in debugging and refining R code for data analysis. No portion of the main text was generated from scratch by AI. Furthermore, AI tools did not participate in the design of the study, the interpretation of the results, or the creation of any images presented in this manuscript. The authors have carefully reviewed the final text and code, and take full responsibility for the content and integrity of the publication.

Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Nhan dan Gia Dinh Hospital (approval No. 95/NDGD-HĐĐĐ, August 15, 2023). All procedures were conducted in accordance with the ethical standards of the Declaration of Helsinki.

Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The de-identified dataset used in this study is available from the corresponding author upon reasonable request, subject to approval by the Institutional Review Board and in accordance with institutional and national regulations on patient data confidentiality.

Corresponding author: Nguyen-Khoi Le, PhD, Lecturer, Department of Surgery, Faculty of Medicine, Pham Ngoc Thach University of Medicine, 2 Duong Quang Trung, Hoa Hung Ward, Ho Chi Minh City 07000, Viet Nam. tg_lenguyenkhoi@pnt.edu.vn

Received: March 12, 2026
Revised: April 9, 2026
Accepted: June 2, 2026
Published online: July 27, 2026
Processing time: 138 Days and 7.5 Hours

Abstract

BACKGROUND

Percutaneous transhepatic biliary drainage (PTBD) remains an important salvage or urgent drainage option for biliary obstruction when endoscopic retrograde cholangiopancreatography fails or is not feasible. Evidence on bleeding and vascular complications after ultrasound-guided PTBD in low- and middle-income settings remains limited.

AIM

To determine the incidence and identify predictors of bleeding or vascular complications after ultrasound-guided PTBD.

METHODS

We conducted a retrospective single-center cohort study of consecutive adults undergoing index PTBD for benign or malignant biliary obstruction at a tertiary hospital in Southern Vietnam from January 2021 to August 2023. All procedures were performed under real-time ultrasound guidance with color Doppler. Bleeding or vascular complications, defined using standardized criteria, were analyzed as the primary outcome, with clinically significant events reported separately. Associations were evaluated using a reduced Firth penalized logistic regression model including key procedural and disease-related variables, with internal validation by bootstrap resampling.

RESULTS

A total of 234 procedures were analyzed. Overall complications occurred in 33 patients (14.1%) and were predominantly minor. Bleeding or vascular complications occurred in 16 patients (6.8%), including 13 minor bleeding events (5.6%) and 3 clinically significant events (1.3%). No procedure-related mortality was observed within 14 days. Patients with bleeding or vascular complications had more frequent multiple needle passes and longer procedure times. In multivariable analysis, independent predictors included more than one needle pass [adjusted odds ratio (aOR): 7.91, 95% confidence interval (CI): 2.05-30.59], choledocholithiasis (aOR: 18.80, 95%CI: 4.79-73.73), longer procedure time per 10 minutes (aOR: 1.44, 95%CI: 1.05-1.96), and smaller target-duct diameter (aOR: 0.82 per 1 mm increase, 95%CI: 0.69-0.98). The model showed good discrimination (optimism-corrected area under the curve 0.85).

CONCLUSION

Ultrasound-guided percutaneous transhepatic biliary drainage demonstrates a low rate of clinically significant bleeding, with risk driven mainly by procedural difficulty and biliary pathology.

Keywords: Percutaneous transhepatic biliary drainage; Biliary obstruction; Bleeding; Vascular injury; Ultrasound guidance

Core Tip: In this retrospective cohort study, ultrasound-guided percutaneous transhepatic biliary drainage performed without fluoroscopy demonstrated a low rate of clinically significant bleeding (1.3%). Bleeding or vascular complications were primarily associated with procedural difficulty, including multiple needle passes and longer procedure time, as well as anatomical factors such as smaller target-duct diameter. Choledocholithiasis was also strongly associated with increased risk. These findings support the safety and feasibility of ultrasound-guided percutaneous transhepatic biliary drainage in resource-limited settings and highlight key technical factors that may help reduce bleeding complications.