Abstract No. 580 Lower risk of major arterial hemorrhage after percutaneous biliary drainage with primary stent versus primary catheter placement

To compare the incidence of arterial hemorrhage requiring embolization after percutaneous biliary drainage with a primary biliary stent (PBS) vs. a primary biliary drainage catheter (PBDC) placement. This IRB-approved retrospective study included 524 consecutive cancer patients who underwent 548 percutaneous biliary drainage procedures with a PBDC or a PBS between January 2016 and November 2019. Demographic, laboratory, and procedure data were collected after chart and PACS review. Biliary drainage was performed with 278 PBDC in 260 (50%) patients and 270 PBS in 264 (50%) patients. In 65/270 (24%) PBS, a covering catheter was left to ensure decompression. There was no statistically significant difference between the groups in the number of left-sided biliary interventions, INR, and platelet count. Major arterial bleeding requiring embolization occurred after 20/278 (7%) PBDC placements (8/20 in the left side) in 18 patients after a median of 9 days (range, 1–18 days). Only 1/270 (0.4%) PBS, with a covering catheter present, was followed by arterial bleeding requiring embolization after 10 days. There were no patients with PBS only (no covering catheter) that required embolization. The difference in major bleeding episodes after biliary drainage with PBDC vs. PBS was statistically significant (P < .001). Percutaneous biliary drainage with PBS is associated with a lower incidence of major arterial bleeding compared with PBDC. A covering catheter may increase the risk of bleeding after PBS placement.