Predictors of the technical success of ultrasound-guided percutaneous transhepatic biliary drainage for biliary obstruction

doi:10.4240/wjgs.117878

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 18, Issue 8

This Article

(1)

(0)

(3)

Peer-Review Report of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Supplementary Materials of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Journal Information of This Article

Publication Name

World Journal of Gastrointestinal Surgery

ISSN

1948-9366

Publisher of This Article

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

- Full Article (XML)

Retrospective 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. Aug 27, 2026; 18(8): 117878
Published online Aug 27, 2026. doi: 10.4240/wjgs.117878

Predictors of the technical success of ultrasound-guided percutaneous transhepatic biliary drainage for biliary obstruction

Yun Song, Guang-Hai Chen, Lu Peng, Jian Du, Shu-Ming Tan

Yun Song, Jian Du, Department of General Surgery, Suining Hospital of Traditional Chinese Medicine (Affiliated with North Sichuan Medical College), Suining 629000, Sichuan Province, China

Yun Song, Jian Du, School of Integrated Chinese and Western Medicine, North Sichuan Medical College, Suining 629000, Sichuan Province, China

Guang-Hai Chen, Department of General Surgery, Suining Central Hospital, Suining 629000, Sichuan Province, China

Lu Peng, Department of Emergency, Suining Central Hospital, Suining 629000, Sichuan Province, China

Lu Peng, Clinical School of Medicine, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China

Shu-Ming Tan, Department of Ultrasound Medicine, Ziyang Central Hospital (Affiliated with West China Hospital, Sichuan University), Ziyang 641300, Sichuan Province, China

Author contributions: Song Y contributed to conceptualization, study design and theoretical framework; Chen CH contributed to experimental design; Peng L contributed to statistical modeling, computational analysis and interpretation; Du J contributed to investigation; Tan SM contributed to data collection and validation; all authors contributed to critical revision and final approval.

AI contribution statement: DeepSeek was used for translation and AJE (human editing) for polishing. No AI was used for any other purpose.

Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Suining Hospital of Traditional Chinese Medicine (Approval No. 2025080).

Informed consent statement: Patient consent was waived by the approving Institutional Review Board (Suining Hospital of Traditional Chinese Medicine, Approval No. 2025080) because this was a retrospective study analyzing anonymized patient data. All patient data were de-identified prior to analysis to ensure confidentiality.

Conflict-of-interest statement: There are no financial interests/personal relationships that may be construed as potential conflicts of interest.

Data sharing statement: De-identified datasets are available from the corresponding author upon reasonable request, subject to institutional data sharing agreements.

Corresponding author: Lu Peng, Department of Emergency, Suining Central Hospital, No. 27 Dongping North Road, Hedong New District, Suining 629000, Sichuan Province, China. doctorpenglu@outlook.com

Received: December 18, 2025
Revised: February 1, 2026
Accepted: May 27, 2026
Published online: August 27, 2026
Processing time: 241 Days and 16.2 Hours

Abstract

BACKGROUND

Percutaneous transhepatic biliary drainage (PTBD) is a critical minimally invasive intervention for biliary obstruction, with technical success being a key determinant of clinical outcomes.

AIM

To identify and quantify the clinically modifiable factors predicting technical success of ultrasound-guided PTBD, and thereby to develop an evidence-based framework for procedural triage and standardization.

METHODS

A total of 263 ultrasound-guided PTBD procedures performed at three tertiary hospitals (2019-2024) were retrospectively analyzed. Technical success (defined as catheter patency at 2 weeks) and complications were evaluated. Multivariate logistic regression was used to assess provider-related, patient-related, and technical factors, with statistical significance set at P < 0.05.

RESULTS

The cumulative success rate was 94.3% (248/263 cases), with a first-attempt success rate of 72.6% (191/263). Repeat attempts significantly increased cumulative success (P < 0.01) but did not significantly increase the overall complication rate (P = 0.415). The significant predictors in the final multivariable model included operator experience [> 20 cases; odds ratio (OR) = 1.83; 95%CI: 1.12-2.99; P = 0.015], use of dedicated puncture probes (OR = 2.46; 95%CI: 1.16-5.24; P = 0.019), adequate periprocedural cooperation (OR = 2.73; 95%CI: 1.14-6.57; P = 0.025), a bile duct diameter ≥ 6 mm (OR = 2.13; 95%CI: 1.30-3.48; P = 0.003), and a bilirubin concentration > 340 μmol/L (OR = 2.58; 95%CI: 1.52-4.36; P < 0.001). These predictors were incorporated into a practical bedside scoring system to stratify procedural success probability.

CONCLUSION

This study proposes a preliminary framework for standardizing ultrasound-guided PTBD by identifying three actionable determinants: Operator experience (> 20 procedures), a defined reattempt limit (≤ 2 attempts), and specific anatomic-biochemical criteria (bile duct diameter ≥ 6 mm and bilirubin concentration > 340 μmol/L). The use of dedicated puncture probes is a key technical modifier. This framework translates evidence into practical decision support, providing a foundation for protocol formalization and prospective validation.

Keywords: Percutaneous transhepatic biliary drainage; Ultrasound guidance; Biliary obstruction; Technical success; Predictive factors

Core Tip: This multicenter study established the first evidence-based clinical decision-making framework for predicting technical success in ultrasound-guided percutaneous transhepatic biliary drainage (PTBD). Key actionable determinants were identified: Operator experience (> 20 procedures), bile duct diameter (≥ 6 mm), and the severity of obstruction (bilirubin > 340 μmol/L). The framework also defines a safe procedural limit (≤ 2 attempts) and identifies the use of dedicated puncture probes as a critical technical enhancer. This work translates evidence into practical guidance and provides a foundation for standardizing PTBD protocols.