Percutaneous management of benign biliary strictures

Abstract Background Postoperative biliary strictures are commonly related to accidental bile duct injuries or occur at the site of biliary anastomosis. The first-line treatment for benign biliary strictures is endoscopic therapy, which is less invasive and repeatable. However, recanalization for biliary complete obstruction is technically challenging to treat. The present report describes a successful case of treatment by extraluminal recanalization for postoperative biliary obstruction using a transseptal needle. Case presentation A 66-year-old woman had undergone caudal lobectomy for the treatment of hepatocellular carcinoma. The posterior segmental branch of the bile duct was injured and repaired intraoperatively. Three months after the surgery, the patient had developed biliary leakage from the right hepatic bile duct, resulting in complete biliary obstruction. Since intraluminal recanalization with conventional endoscopic and percutaneous approaches with a guidewire failed, extraluminal recanalization using a transseptal needle with an internal lumen via percutaneous approach was performed under fluoroscopic guidance. The left lateral inferior segmental duct was punctured, and an 8-F transseptal sheath was introduced into the ostium of right hepatic duct. A transseptal needle was advanced, and the right hepatic duct was punctured by targeting an inflated balloon that was placed at the end of the obstructed right hepatic bile duct. After confirming successful puncture using contrast agent injected through the internal lumen of the needle, a 0.014-in. guidewire was advanced into the right hepatic duct. Finally, an 8.5-F internal–external biliary drainage tube was successfully placed without complications. One month after the procedure, the drainage tube was replaced with a 10.2-F drainage tube to dilate the created tract. Subsequent endoscopic internalization was performed 5 months after the procedure. At the 1-year follow-up examination, there was no sign of biliary obstruction and recurrence of hepatocellular carcinoma. Conclusions Recanalization using a transseptal needle can be an alternative technique for rigid biliary obstruction when conventional techniques fail.

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A Prospective Multicenter Study of “Inside Stents” for Biliary Stricture: Multicenter Evolving Inside Stent Registry (MEISteR)

Journal of Clinical Medicine ◽

10.3390/jcm10132936 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2936

Author(s):

Hirofumi Kogure ◽

Hironari Kato ◽

Kazumichi Kawakubo ◽

Hirotoshi Ishiwatari ◽

Akio Katanuma ◽

...

Keyword(s):

Multicenter Study ◽

Stent Placement ◽

Controlled Trial ◽

Adverse Event Rate ◽

Success Rates ◽

Technical Success ◽

Biliary Strictures ◽

Prospective Multicenter Study ◽

Stent Occlusion ◽

Benign Biliary Strictures

Background: Endoscopic biliary stent placement is the standard of care for biliary strictures, but stents across the papilla are prone to duodenobiliary reflux, which can cause stent occlusion. Preliminary studies of “inside stents” placed above the papilla showed encouraging outcomes, but prospective data with a large cohort were not reported. Methods: This was a prospective multicenter registry of commercially available inside stents for benign and malignant biliary strictures. Primary endpoint was recurrent biliary obstruction (RBO). Secondary endpoints were technical success of stent placement and removal, adverse events, and stricture resolution. Results: A total of 209 inside stents were placed in 132 (51 benign and 81 malignant) cases with biliary strictures in 10 Japanese centers. During the follow-up period of 8.4 months, RBO was observed in 19% of benign strictures. The RBO rate was 49% in malignant strictures, with the median time to RBO of 4.7 months. Technical success rates of stent placement and removal were both 100%. The adverse event rate was 8%. Conclusion: This prospective multicenter study demonstrated that inside stents above the papilla were feasible in malignant and benign biliary strictures, but a randomized controlled trial is warranted to confirm its superiority to conventional stents across the papilla.

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Balloon dilatation of benign biliary strictures.

Radiology ◽

10.1148/radiology.151.3.6718718 ◽

1984 ◽

Vol 151 (3) ◽

pp. 613-616 ◽

Cited By ~ 20

Author(s):

E Salomonowitz ◽

W R Castaneda-Zuniga ◽

G Lund ◽

A H Cragg ◽

D W Hunter ◽

...

Keyword(s):

Balloon Dilatation ◽

Biliary Strictures ◽

Benign Biliary Strictures

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Metallic stents in benign biliary strictures: Three-year follow-up

CardioVascular and Interventional Radiology ◽

10.1007/bf02734119 ◽

1992 ◽

Vol 15 (6) ◽

pp. 360-366 ◽

Cited By ~ 49

Author(s):

Francesca Maccioni ◽

Michele Rossi ◽

Filippo Maria Salvatori ◽

Paolo Ricci ◽

Mario Bezzi ◽

...

Keyword(s):

Metallic Stents ◽

Biliary Strictures ◽

Benign Biliary Strictures

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Author′s response: Endoscopic biodegradable biliary stents in the treatment of benign biliary strictures: First report of clinical use in patients

Digestive Endoscopy ◽

10.1111/den.12911 ◽

2017 ◽

Vol 29 (6) ◽

pp. 732-732

Author(s):

Antti Siiki ◽

Irina Rinta‐Kiikka ◽

Johanna Laukkarinen

Keyword(s):

Clinical Use ◽

Biliary Strictures ◽

Biliary Stents ◽

First Report ◽

Benign Biliary Strictures

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Percutaneous management of benign biliary strictures with balloon dilation and self-expanding metallic stents

CardioVascular and Interventional Radiology ◽

10.1007/bf02578024 ◽

1990 ◽

Vol 13 (4) ◽

pp. 231-239 ◽

Cited By ~ 16

Author(s):

Plinio Rossi ◽

Filippo M. Salvatori ◽

Mario Bezzi ◽

Francesca Maccioni ◽

Mario L. Porcaro ◽

...

Keyword(s):

Balloon Dilation ◽

Metallic Stents ◽

Biliary Strictures ◽

Benign Biliary Strictures

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Percutaneous Management of Benign Biliary Strictures

Seminars in Interventional Radiology ◽

10.1055/s-0041-1731087 ◽

2021 ◽

Vol 38 (03) ◽

pp. 291-299

Author(s):

Adam Fang ◽

Il Kyoon Kim ◽

Ifechi Ukeh ◽

Vahid Etezadi ◽

Hyun S. Kim

Keyword(s):

Treatment Options ◽

Balloon Dilation ◽

Percutaneous Transhepatic Cholangiography ◽

Team Approach ◽

Biliary Strictures ◽

Surgical Interventions ◽

Benign Biliary Strictures ◽

Elevated Liver Enzymes ◽

Biodegradable Stents ◽

Asymptomatic Disease

AbstractBenign biliary strictures are often due to a variety of etiologies, most of which are iatrogenic. Clinical presentation can vary from asymptomatic disease with elevated liver enzymes to obstructive jaundice and recurrent cholangitis. Diagnostic imaging methods, such as ultrasound, multidetector computed tomography, and magnetic resonance imaging (cholangiopancreatography), are used to identify stricture location, extent, and possible source of biliary obstruction. The management of benign biliary strictures requires a multidisciplinary team approach and include endoscopic, percutaneous, and surgical interventions. Percutaneous biliary interventions provide an alternative diagnostic and therapeutic approach, especially in patients who are not amenable to endoscopic evaluation. This review provides an overview of benign biliary strictures and percutaneous management by interventional radiologists. Diagnostic evaluation with percutaneous transhepatic cholangiography and treatment options, including biliary drainage, balloon dilation, retrievable/biodegradable stents, and other innovative minimally invasive options, are discussed.

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