Method of Increasing Luminal Scaffolding for Biliary Strictures

Benign biliary strictures are a common clinical entity encountered by the interventionalist. Balloon dilatation is an acceptable modality of treatment, but restenosis is frequent. The recoil that follows balloon dilatation of recalcitrant benign biliary strictures presents a treatment challenge. This chapter presents a single-access dual-drainage catheter technique that has been employed successfully for more than 6 years. The procedure involves the standard placement of a large drainage catheter (ideally 14 Fr) across the biliary stricture. A second catheter measuring between 5 and 8.5 Fr is advanced through the hub of the 14 Fr drainage catheter and subsequently exits through a proximal hole of the 14 Fr drainage catheter. At the site of the stricture, there is side-by-side placement of the two drainage catheters providing extra scaffolding despite the 14 Fr percutaneous tract.