Procedure-related risk factors for bleeding after percutaneous transhepatic biliary drainage: A systematic review and meta-analysis

J Formos Med Assoc. 2022 Sep;121(9):1680-1688. doi: 10.1016/j.jfma.2021.11.013. Epub 2021 Dec 10.


Background/purpose: Bleeding is the most dreaded complication after percutaneous transhepatic biliary drainage (PTBD). Clarifying the risk factors of bleeding can reduce the morbidity and mortality rates of PTBD. However, the procedure-related risk factors for bleeding after PTBD are still controversial. Therefore, this systematic review and meta-analysis were performed to identify procedure-related risk factors of bleeding after PTBD.

Methods: PubMed, Cochrane database, and Google Scholar were searched for published studies until 1st May 2021. Inclusion criteria were: studies associated with bleeding complications after PTBD and with sufficient data to compare different procedure-related factors for bleeding. Sources of bias were assessed using the Newcastle-Ottawa Scale and Cochrane risk-of-bias tool for randomised trials. Probable procedure-related risk factors were evaluated and outcomes were expressed in the case of dichotomous variables, as an odds ratio (OR) (with a 95% confidence interval, (CI)).

Results: Eleven studies were included in the meta-analysis. There was no significant difference in bleeding rates with respect to the side of PTBD (left/right, OR = 1.10, 95% CI: 0.68-1.76), the insertion level of bile duct (central/peripheral, OR = 1.39, 95% CI: 0.82-2.35), and the usage of ultrasound guidance (OR: 1.25, 95% CI: 0.60-2.60). A subgroup analysis revealed a left-sided approach that resulted in more hepatic arterial injuries than the right-sided approach (left/right, OR = 1.93, 95% CI: 1.32-2.83).

Conclusion: Left-sided approach is a risk factor for hepatic arterial injuries after PTBD.

Keywords: Fluoroscopy; Hemobilia; Interventional; Jaundice; Obstructive; Radiography; Ultrasonography.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Drainage*
  • Hepatic Artery*
  • Humans
  • Liver
  • Retrospective Studies
  • Risk Factors
  • Ultrasonography