Structured protocol for benign biliary anastomotic strictures: Impact on long-term clinical effectiveness

Will S. Lindquester, J. David Prologo, Elizabeth A Krupinski, Gail L. Peters

Research output: Contribution to journalArticle

Abstract

OBJECTIVE. The purpose of this study is to compare long-term clinical effectiveness before and after implementation of a structured protocol for percutaneous drainage of benign anastomotic biliary strictures. MATERIALS AND METHODS. Three hundred fve adult patients undergoing percutaneous biliary drainage for biliary anastomotic strictures between 1994 and 2015 were identifed using Current Procedural Terminology billing codes, with 234 undergoing intervention before implementation of a structured protocol and 71 undergoing intervention after implementation of the protocol. The frequency of surgical anastomotic revision was compared between patients treated before and after the implementation of the structured protocol. Patient characteristics and treatment variables were also analyzed with respect to the frequency of surgical revision. A Kaplan-Meier analysis was performed to determine the long-term probabilities of avoiding surgical revision and patency rates. RESULTS. Overall, 72.8% of patients avoided surgical revision, with 71.1% before and 81.7% after the protocol was implemented (p = 0.1052). A larger maximum drain size was signifcantly associated with a lower frequency of surgical revision (p = 0.0006). The rates of surgical avoidance 5 years after treatment before and after protocol implementation were 69.1% and 80.8%, respectively. Patency rates 5 years after treatment before and after protocol implementation were 73.8% and 76.8%, respectively. CONCLUSION. Percutaneous drainage and management of benign biliary anastomotic strictures is an effective treatment regardless of the presence of a structured protocol. Although there was no signifcant beneft in terms of avoidance of surgical revision, the time until surgical revision and patency rates were increased with the protocol. In addition, a larger maximum drain size was associated with a better outcome.

Original languageEnglish (US)
Pages (from-to)447-453
Number of pages7
JournalAmerican Journal of Roentgenology
Volume210
Issue number2
DOIs
StatePublished - Feb 1 2018
Externally publishedYes

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Reoperation
Pathologic Constriction
Drainage
Current Procedural Terminology
Kaplan-Meier Estimate
Therapeutics

Keywords

  • Benign biliary stricture
  • Clinical effectiveness
  • Hepatobiliary interventions
  • Percutaneous biliary drainage

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Structured protocol for benign biliary anastomotic strictures : Impact on long-term clinical effectiveness. / Lindquester, Will S.; David Prologo, J.; Krupinski, Elizabeth A; Peters, Gail L.

In: American Journal of Roentgenology, Vol. 210, No. 2, 01.02.2018, p. 447-453.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE. The purpose of this study is to compare long-term clinical effectiveness before and after implementation of a structured protocol for percutaneous drainage of benign anastomotic biliary strictures. MATERIALS AND METHODS. Three hundred fve adult patients undergoing percutaneous biliary drainage for biliary anastomotic strictures between 1994 and 2015 were identifed using Current Procedural Terminology billing codes, with 234 undergoing intervention before implementation of a structured protocol and 71 undergoing intervention after implementation of the protocol. The frequency of surgical anastomotic revision was compared between patients treated before and after the implementation of the structured protocol. Patient characteristics and treatment variables were also analyzed with respect to the frequency of surgical revision. A Kaplan-Meier analysis was performed to determine the long-term probabilities of avoiding surgical revision and patency rates. RESULTS. Overall, 72.8{\%} of patients avoided surgical revision, with 71.1{\%} before and 81.7{\%} after the protocol was implemented (p = 0.1052). A larger maximum drain size was signifcantly associated with a lower frequency of surgical revision (p = 0.0006). The rates of surgical avoidance 5 years after treatment before and after protocol implementation were 69.1{\%} and 80.8{\%}, respectively. Patency rates 5 years after treatment before and after protocol implementation were 73.8{\%} and 76.8{\%}, respectively. CONCLUSION. Percutaneous drainage and management of benign biliary anastomotic strictures is an effective treatment regardless of the presence of a structured protocol. Although there was no signifcant beneft in terms of avoidance of surgical revision, the time until surgical revision and patency rates were increased with the protocol. In addition, a larger maximum drain size was associated with a better outcome.",
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N2 - OBJECTIVE. The purpose of this study is to compare long-term clinical effectiveness before and after implementation of a structured protocol for percutaneous drainage of benign anastomotic biliary strictures. MATERIALS AND METHODS. Three hundred fve adult patients undergoing percutaneous biliary drainage for biliary anastomotic strictures between 1994 and 2015 were identifed using Current Procedural Terminology billing codes, with 234 undergoing intervention before implementation of a structured protocol and 71 undergoing intervention after implementation of the protocol. The frequency of surgical anastomotic revision was compared between patients treated before and after the implementation of the structured protocol. Patient characteristics and treatment variables were also analyzed with respect to the frequency of surgical revision. A Kaplan-Meier analysis was performed to determine the long-term probabilities of avoiding surgical revision and patency rates. RESULTS. Overall, 72.8% of patients avoided surgical revision, with 71.1% before and 81.7% after the protocol was implemented (p = 0.1052). A larger maximum drain size was signifcantly associated with a lower frequency of surgical revision (p = 0.0006). The rates of surgical avoidance 5 years after treatment before and after protocol implementation were 69.1% and 80.8%, respectively. Patency rates 5 years after treatment before and after protocol implementation were 73.8% and 76.8%, respectively. CONCLUSION. Percutaneous drainage and management of benign biliary anastomotic strictures is an effective treatment regardless of the presence of a structured protocol. Although there was no signifcant beneft in terms of avoidance of surgical revision, the time until surgical revision and patency rates were increased with the protocol. In addition, a larger maximum drain size was associated with a better outcome.

AB - OBJECTIVE. The purpose of this study is to compare long-term clinical effectiveness before and after implementation of a structured protocol for percutaneous drainage of benign anastomotic biliary strictures. MATERIALS AND METHODS. Three hundred fve adult patients undergoing percutaneous biliary drainage for biliary anastomotic strictures between 1994 and 2015 were identifed using Current Procedural Terminology billing codes, with 234 undergoing intervention before implementation of a structured protocol and 71 undergoing intervention after implementation of the protocol. The frequency of surgical anastomotic revision was compared between patients treated before and after the implementation of the structured protocol. Patient characteristics and treatment variables were also analyzed with respect to the frequency of surgical revision. A Kaplan-Meier analysis was performed to determine the long-term probabilities of avoiding surgical revision and patency rates. RESULTS. Overall, 72.8% of patients avoided surgical revision, with 71.1% before and 81.7% after the protocol was implemented (p = 0.1052). A larger maximum drain size was signifcantly associated with a lower frequency of surgical revision (p = 0.0006). The rates of surgical avoidance 5 years after treatment before and after protocol implementation were 69.1% and 80.8%, respectively. Patency rates 5 years after treatment before and after protocol implementation were 73.8% and 76.8%, respectively. CONCLUSION. Percutaneous drainage and management of benign biliary anastomotic strictures is an effective treatment regardless of the presence of a structured protocol. Although there was no signifcant beneft in terms of avoidance of surgical revision, the time until surgical revision and patency rates were increased with the protocol. In addition, a larger maximum drain size was associated with a better outcome.

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