101 - Efficacy of Biliary Drainage in Achieving Target Bilirubin Levels for Subsequent Chemotherapy Administration in Patients with Pre-drainage Bilirubin Levels >10 mg/dL

Purpose: To assess percutaneous biliary drain (PBD) indication in malignant biliary obstruction in patients with total bilirubin (TB) >10 mg/dL and evaluate rate of chemotherapy receipt relative to intent following drainage. To determine the efficacy of PBD in achieving TB levels at acceptable levels for chemotherapy administration ( < 5 and < 2 mg/dL).

Materials and Methods: Retrospective cohort of 99 patients with a pre-drain TB >10 mg/dL (55.6% male, mean age 67 years) undergoing PBD for malignant obstruction (2020-2025). Primary malignancies: pancreatic (32), cholangiocarcinoma (25), upper gastrointestinal (13), colorectal metastases (12), gallbladder (5), breast (4), hematologic (4), hepatocellular carcinoma (2), others (2). Data collected: number of drain/s placed, TB values prior to/after drain placement, treatment intent and receipt.

Results: Twenty-two patients (22%) had 2 PBDs placed and 5 (5%) had 3+ PBDs placed. Average TB prior to first PBD was 17.2 mg/dL. Average TB prior to second was 10.7 (7.1 for 3+ drains). Average lowest TB after single PBD was 6.8 mg/dL and 7.9 after two. Of patients with a single PBD, a TB < 2 and < 5 mg/dL was achieved in 25 (25.5%) and 47 (47.9%), respectively. For patients with 2 drains, a TB < 2 and < 5 mg/dL was achieved in 7 (30.4%) and 23 (47.8%), respectively. Average number of days to achieve a TB < 2 and < 5 mg/dL after 1 PBD was 20 days and 19 days. Mean and median survival were 118 and 50 days from PBD placement. Biliary drainage was performed in 84 (87.7%) patients with the primary indication of lowering TB to allow for subsequent chemotherapy. Of those patients, 36 (42.9%) received chemotherapy. The rate of chemotherapy administration varied based on cancer type (46.2% upper GI, 37.5% pancreatic, 33.3% colorectal, 36.0% cholangiocarcinoma, 25% breast, 100% hematologic, 0% for gallbladder, hepatocellular carcinoma, and other).

Conclusion: This analysis demonstrates the low rates of chemotherapy receipt relative to intent following PBD. Less than half of patients achieve a TB < 5 mg/dL after PBD placement. Placement of PBD with the goal of lowering TB to allow for chemotherapy administration, should be carefully weighed against the morbidity associated with PBD, particularly in patients with malignancies known to have poor survival. Additional studies with expanded cohorts should be performed to substantiate these findings.