 Good evening all the fellows and the delegates. Myself, Dr. Nithya Yadav, junior resident and second year from the department of radiative diagnosis, IMSVHU, and my papers topic is Percorinus transapathic dilute drainage in malignant observation, obstruction. It is an observation study done at our center. So gallbladder cancer has a very poor prognosis with overall survival of only five to 20%. And most of the patients die within the first six months of their diagnosis. Jondas and gallbladder are coupled into carcinoma is due to severe invasions of gallbladder neck mass, pylum invasion by infiltrative mass, lymph node compression, intraluminal tumor extension, or liver metastasis. Jondas will occurs in gallbladder or parandrocarcinoma, makes the patient want a manoeuvre to surgical or chemotherapy treatment. And spallary drainage is the first and most important step for palliation. Percorinus spallary drainage after endoscopic drainage or surgery is one of the methods for the ureteranage. Most of the patients first endoscopically the ureteranage is striped and if it is spale, but the traneous ureteranage is dumped under fluoroscopy or agression of both. The aim of the study was to determine outcome complication impact on quality of life of PTVD patients presented with malignant obstructive germless. It is an observational study from 1st February to 1st March, 2022 in patients which came to our department, referred from the surgical oncology with obstructive germless due to all gallbladder or parandrocarcinoma. Whenever the patient come after planning the patient for PTVD, we first take a written informed consent by all the patients and during the planning CBC, LFP, RFP, viral markers with the IRR and ultrasound abdominals done. The study was done for assessment of the ascitus to the equation level of obstruction by the mask and whether the directed ducts are present or not. In patients with DDH-Ptiana, we first correct the PT-iana by LFP translation during or before the procedure. Whenever the patient has ascitus, we drain the ascitus by Malikot catheter insertion and if the albumin is DDH, we give the IV albumin coverage also. Patient is followed after the PTVD for any complication for one month. During the procedure, all the procedures were performed under local anesthesia by 2% lignoking injection and first with the ultrasound guidance, a peripheral bile duct is seen for a good puncture and preferably at our center, we chose the right ideal septuval duct. However, if there is a right level of atrophy or there is metastasis in the path of the preferred bile duct, we choose a different duct or from the left level lobe. If the functional level is mostly by the left level lobe. After the puncture by achievement level, which is a 20 gauge level, whenever the pre flow of the bile is, bile comes, we first take the total 3 ml for the bile puncture insensitivity and after that a guide wire is passed to the puncture needle and exchanged with the sheath. On the sheath, the end of the guide wire is then advanced in the bile duct and over it, come to character is advanced. Multiple phyllogeograms are taken and the whole system is manipulated through the bile duct. Whenever there is a maximum narrowing, we try to manipulate it through the structure. If the structure is not passed, then we either do the external drainage by malefath catheter of 8 trains. And if the structure is passed, then we will go further to the duodenum and then exchange it to the duodenum barycatheter of 8 trains. The phylloctic antibiotic coverage is given to all of our patients and then the diaculture and sensitivity reports come. We change the antibiotic according to the sensitivity. So these are the fluoroscopic images which were taken during the PTVD procedure in all of our patients. The first is the phyllogeogram taken after the initial puncture. We can see a straight chiba needle and the right end here is a pyridactyla diacritic. The second image is taken from a comfy catheter and we can see the maximum point of narrowing in the proximal cili. The third image is after the ring-bellied catheter placement and we can see the duodenal pores which are all specified by the dye. So we sampled total 19 patients two were from less than 30 years, seven were from 35 years, six were from 40 to 60 years, age two and four were more than 60 years of age two. Here we can see that majority of the patients are different from 60 years. So one set of the gallbladder opalendoplasma which are indepictive is very early. Among the total patients, eight were males and 11 were females. As I have told, we prefer the right approach whenever we first puncture the needle. So in our 19 patients, 15 patients were approached from the right side and three patients were approached from the left side. In among these three patients, one was initially punctured from the left side and the other two were first tried from the right side and then when we were able to manipulate across the structure, we prefer the right. We then shifted to the left side and in one patient, both right and left system drainage was done as there was imputation of the hyalum and both the systems were separate. In two patients, external drainage was done as we were unable to pass through the structure. In 16 patients, external internal ring baryary catheter was placed and in one patient, stent was placed in a later of a followup period after one month. During the procedure, two patients showed complication as initial puncture bleed. However, the bleed was stopped immediately and there was no further complication in those two patients. Two patients and other showed the complications after the procedure within the one key. Two patients had cholangitis, five patients had patecatecholene, four patients had the spaced catheter tip and one had other complication which was procedurally related and it was patecate-sudoannulism. However, that pseudoannulism was also managed at our center by annualization. During the followup, 16 patients were alive in the first week. 10 patients were alive after the second week and seven patients were alive after the complete followup. So we can see initially, within the two weeks, majority of half of the patient died and it was most likely due to the terminal A patient as most of the patients which are referred to us are at the last stage of their cancer. After the procedure, there was significant reduction in total bilirubin, in total six patients after the one week and among these four patients were started on chemotherapy during the followup period. And in two patients, repeat PTBD was done because of the space in the lower catheter. Pericatheter lead was treated by either B-sutrient or upsided in the catheter and pericatheter lead was the most common complication in our followup. The bio-culture which was sent during the procedure was derived in eight patients. Subramanas aeruginosa infection was seen in three patients and all of these died before completing antibiotic treatment that is within the first week. And E. coli was detected in patients in which the antibiotic was changed and patients were okay after the followup. So PTBD has a standard procedure used to relieve obstructive jaundice in malignant delivery obstruction which is secondary to wall bladder of pharyngeal passeroma. It reduces the risk of phalangitis. It is a feasible procedure. Complications are common in PTBD with a total dislodgement, phalangitis and pericatheter lead being the most common. At our center, pericatheter lead was most common. Complications are more common in external PTBD drainage and external internal drainage. A randomized study compared PTBD procedure with endoscopic drainage in the customer wall bladder and it showed that there was improved output in the form of better success rate in PTBD. And low incidence of pharyngeitis. However, there was no significant change in the quality of life of patients because these patients have not terminally also weight loss, reduced appetite, all these features and pain and dominoes, all these features continue to be there even after the PTBD procedure and reduce pallorubin levels. And various studies evaluate the quality of life after PTBD in malignant hyalurabstruction and showed a significant decrease in quality of life after PTBD. It was most likely due to the complications related to the PTBD procedure. In conclusion, John is due to pulmonary cancer, have a high incidence of locally advanced and metastatic disease. Lary drainage should be done to relieve patient's symptom, improve quality of life, and enable further treatment. However, there is no significant improvement in quality of life by higher success rate in rate of PTBD. But adequate post-prohetic care can improve their outcome in PTBD. Thank you. These are my references.