{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T22:48:22Z","timestamp":1792622902165,"version":"4.5.0"},"reference-count":31,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2020,1,23]],"date-time":"2020-01-23T00:00:00Z","timestamp":1579737600000},"content-version":"unspecified","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,11,15]]},"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Relieving obstructive jaundice in inoperable pancreato-biliary cancers improves quality of life and permits chemotherapy. Percutaneous transhepatic cholangiography with drainage and\/or stenting relieves jaundice but can be associated with significant morbidity and mortality. Percutaneous transhepatic biliary drainage (PTBD) in malignant biliary obstruction was therefore examined in a national cohort to establish risk factors for poor outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective study of adult patients undergoing PTBD for palliation of pancreato-biliary cancer in England between 2001 and 2014 identified from Hospital Episode Statistics. Multivariate logistic regression analysis was used to examine associations with mortality and the need for a repeat PTBD within 2 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>16\u2009822 patients analysed (median age 72 (range 19\u2013104) years, 50.3% men). 58% pancreatic and 30% biliary tract cancer. In-hospital and 30-day mortality were 15.3% (95% CI 14.7% to 15.9%) and 23.1% (22.4%\u201323.8%), respectively. 20.2% suffered a coded complication within 3 months. Factors associated with 30-day mortality: age (\u226581 years OR 2.68 (95% CI 2.37 to 3.03), p&lt;0.001), increasing comorbidity (Charlson score 20+, 3.10 (2.64\u20133.65), p&lt;0.001), pre-existing renal dysfunction (2.37 (2.12\u20132.65), p&lt;0.001) and non-pancreatic cancer (unspecified biliary tract 1.28 (1.08\u20131.52), p=0.004). Women had lower mortality (0.91 (0.84\u20130.98), p=0.011), as did patients undergoing PTBD in a \u2018higher volume\u2019 provider (84\u2013180 PTBDs per year 0.68 (0.58\u20130.79), p&lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients undergoing PTBD for the palliation of malignant biliary obstruction, 30-day mortality was high at 23.1%. Mortality was higher in older patients, men, those with increasing comorbidity, a cancer site other than pancreas and at \u2018lower-volume\u2019 PTBD providers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-033576","type":"journal-article","created":{"date-parts":[[2020,1,24]],"date-time":"2020-01-24T04:15:45Z","timestamp":1579839345000},"page":"e033576","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":71,"title":["The outcomes of biliary drainage by percutaneous transhepatic cholangiography for the palliation of malignant biliary obstruction in England between 2001 and 2014: a retrospective cohort study"],"prefix":"10.1136","volume":"10","author":[{"given":"James","family":"Rees","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Dudley Group of Hospitals NHS Trust, Dudley, West Midlands, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jemma","family":"Mytton","sequence":"additional","affiliation":[{"name":"Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9378-7548","authenticated-orcid":false,"given":"Felicity","family":"Evison","sequence":"additional","affiliation":[{"name":"Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamarjit Singh","family":"Mangat","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore"},{"name":"Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prashant","family":"Patel","sequence":"additional","affiliation":[{"name":"Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nigel","family":"Trudgill","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,1,23]]},"reference":[{"key":"2025121403204389000_10.1.e033576.1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2010.0075"},{"key":"2025121403204389000_10.1.e033576.2","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-007-0796-6"},{"key":"2025121403204389000_10.1.e033576.3","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1016\/j.cgh.2008.03.028","article-title":"Endoscopic or percutaneous biliary drainage for gallbladder cancer: a randomized trial and quality of life assessment","volume":"6","author":"Saluja","year":"2008","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2025121403204389000_10.1.e033576.4","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1097\/MCG.0b013e318272440e","article-title":"Effect of endoscopic stenting of malignant bile duct obstruction on quality of life","volume":"47","author":"Barkay","year":"2013","journal-title":"J Clin Gastroenterol"},{"key":"2025121403204389000_10.1.e033576.5","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2006.09.2551"},{"key":"2025121403204389000_10.1.e033576.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0908721"},{"key":"2025121403204389000_10.1.e033576.7","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6605211"},{"key":"2025121403204389000_10.1.e033576.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2005.02.021"},{"key":"2025121403204389000_10.1.e033576.9","unstructured":"Health and Social Care Information Centre . 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