Percutaneous Transhepatic Intervention for Malignant Biliary Obstruction

2020 ◽  
Author(s):  
Trong Binh Le
Keyword(s):  
Biliary Obstruction ◽  
Multidisciplinary Approach ◽  
Endoscopic Biliary Drainage ◽  
Success Rates ◽  
Acceptable Risk ◽  
Proper Patient Selection ◽  
Percutaneous Transhepatic Drainage ◽  
Comprehensive Knowledge ◽  
Surgical Bypass ◽  
Transhepatic Drainage

Biliary obstruction is a serious clinical condition resulting from either benign or malignant etiologies. For malignant obstruction, curative resection is rarely performed due to disease progression, thus decompression drainage is the management of choice. Percutaneous transhepatic drainage and stenting are effective alternative treatments to surgical bypass and endoscopic biliary drainage when these two modalities are contraindicated. Percutaneous biliary intervention is safe and effective in both drainage and restoration of bile flow with high successful rate and acceptable risk of complication. Multidisciplinary approach, proper patient selection, careful image review and comprehensive knowledge of available techniques, success rates and complications are utmost importance for a successful procedure.

scholarly journals Percutaneous transhepatic drainage is safe and effective in biliary obstruction—A single-center experience of 599 patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260223
Author(s):  
Bálint Kokas ◽  
Attila Szijártó ◽  
Nelli Farkas ◽  
Miklós Ujváry ◽  
Szabolcs Móri ◽  
...  
Keyword(s):  
Success Rate ◽  
Extrahepatic Bile Duct ◽  
Treatment Algorithm ◽  
Success Rates ◽  
Technical Success ◽  
Tertiary Referral Center ◽  
Technical Success Rate ◽  
Percutaneous Transhepatic Drainage ◽  
First Choice ◽  
Transhepatic Drainage

Background Historically, surgical bilioenteric bypass was the only treatment option for extrahepatic bile duct obstruction, but with technological advancements, percutaneous transhepatic drainage (PTD) and endoscopic solutions were introduced as a less invasive alternative. Endoscopic methods may lead to a decreasing indication of PTD in the future, but today it is still the standard treatment method, especially in hilar obstructions. Methods In our retrospective data analysis, we assessed technical success rate, reintervention rate, morbidity, mortality, and the learning curve of patients treated with PTD over 12 years in a tertiary referral center. Results 599 patients were treated with 615 percutaneous interventions. 94.5% (566/599) technical success rate; 2.7% (16/599) reintervention rate were achieved. 111 minor and 22 major complications occurred including 1 case of death. In perihilar obstruction, cholangitis were significantly more frequent in cases where endoscopic retrograde cholangiopancreatography had also been performed prior to PTD compared to PTD alone, with 39 (18.2%) and 15 (10.5%) occurrences, respectively. Discussion The results and especially the excellent success rates demonstrate that PTD is safe and effective, and it is appropriate for first choice in the treatment algorithm of perihilar stenosis. Ultimately, we concluded that PTD should be performed in experienced centers to achieve low mortality, morbidity, and high success rates.

scholarly journals Endoscopic side-by-side uncovered self-expandable metal stent placement for malignant hilar biliary obstruction

2019 ◽  
Vol 12 ◽  
pp. 263177451984634 ◽  
Author(s):  
Katsuya Kitamura ◽  
Akira Yamamiya ◽  
Yu Ishii ◽  
Yuta Mitsui ◽  
Hitoshi Yoshida
Keyword(s):  
Adverse Events ◽  
Stent Placement ◽  
Biliary Obstruction ◽  
Arterial Embolization ◽  
Metal Stents ◽  
Success Rates ◽  
Metal Stent ◽  
Hilar Biliary Obstruction ◽  
Malignant Hilar Biliary Obstruction ◽  
Self Expandable Metal Stent

Aim: To investigate outcomes of endoscopic bilateral side-by-side placement across the papilla using 10-mm-diameter uncovered self-expandable metal stents for unresectable malignant hilar biliary obstruction. Methods: We retrospectively analyzed 23 patients who underwent endoscopic biliary uncovered self-expandable metal stent placement for unresectable malignant hilar biliary obstruction between January 2015 and September 2016 at our institution. We performed endoscopic side-by-side placement across the papilla using 10-mm-diameter longer-model uncovered self-expandable metal stents. Outcomes included the technical and functional success rates, recurrent biliary obstruction rate, time to recurrent biliary obstruction, reintervention rate, and incidence of adverse events other than recurrent biliary obstruction. Results: Of the 23 patients, 10 with malignant hilar biliary obstruction underwent endoscopic side-by-side uncovered self-expandable metal stent placement across the papilla (median age, 83 years; 6 men). The locations of malignant hilar biliary obstruction were Bismuth types II ( n = 3), III ( n = 3), and IV ( n = 4). The median common bile duct diameter was 8 mm. The technical and functional success rates were 100% and 80%, respectively. Seven patients (70%) developed recurrent biliary obstruction because of stent occlusions, including early hemobilia in two patients and late tumor ingrowth in five patients. The median time to recurrent biliary obstruction was 66 (95% confidence interval: 29–483) days. Six patients (60%) required reintervention, and 1 (10%) underwent transcatheter arterial embolization for right hepatic arterial pseudoaneurysm. Early adverse events other than recurrent biliary obstruction occurred in four patients and late adverse event in one patient. Conclusion: Endoscopic side-by-side placement across the papilla using 10-mm-diameter uncovered self-expandable metal stents was technically feasible for unresectable malignant hilar biliary obstruction; however, it might be better to avoid this method for patients with malignant hilar biliary obstruction because of high recurrent biliary obstruction rate and shorter time to recurrent biliary obstruction.

Percutaneous transhepatic drainage and insertion of an endoprosthesis for obstructive jaundice

1983 ◽  
Vol 145 (6) ◽  
pp. 763-768 ◽  
Author(s):  
Dirk J. Gouma ◽  
Robert I.C. Wesdorp ◽  
Robert J. Oostenbroek ◽  
Peter B. Soeters ◽  
Jacobus M. Greep
Keyword(s):  
Obstructive Jaundice ◽  
Percutaneous Transhepatic Drainage ◽  
Transhepatic Drainage

scholarly journals Side-by-side partially covered self-expandable metal stent placement for malignant hilar biliary obstruction

2017 ◽  
Vol 05 (12) ◽  
pp. E1211-E1217 ◽  
Author(s):  
Katsuya Kitamura ◽  
Akira Yamamiya ◽  
Yu Ishii ◽  
Yuta Mitsui ◽  
Tomohiro Nomoto ◽  
...  
Keyword(s):  
Stent Placement ◽  
Biliary Obstruction ◽  
Success Rates ◽  
Metal Stent ◽  
Stent Removal ◽  
Tumor Ingrowth ◽  
Hilar Biliary Obstruction ◽  
Malignant Hilar Biliary Obstruction ◽  
Self Expandable Metal Stent

Abstract Background and study aims This study investigated the feasibility of side-by-side (SBS) partially covered self-expandable metal stent (PCSEMS) placement for unresectable malignant hilar biliary obstruction (MHBO). Patients and methods We retrospectively analyzed 33 patients from a single center who underwent endoscopic biliary drainage for unresectable MHBO from July 2013 to June 2015. In all patients with bilateral obstruction during complete bilateral intrahepatic cholangiograms, we performed endoscopic SBS placement of a 6-mm diameter PCSEMS using an 8-French delivery system. All patients underwent endoscopic sphincterotomy. Generally, patients with recurrent biliary obstruction (RBO) after stent placement underwent endoscopic reintervention. Our study outcomes included the technical and functional success rates, RBO rate, time to RBO (TRBO), reintervention rate, and incidence of adverse events. Results Seventeen patients with unresectable MHBO during complete bilateral intrahepatic cholangiograms underwent endoscopic SBS PCSEMS placement (median age, 78 years; men, 9). Lesions were Bismuth types II (n = 10), III (n = 1), and IV (n = 6), including 10 cholangiocarcinomas, 3 gallbladder cancers, and 4 metastatic cancers. In all patients, the PCSEMS was placed across the duodenal papilla. The technical and functional success rates were 100 % and 82 %, respectively. The median procedure time was 43 minutes (interquartile range [IQR]: 36 – 52 minutes). Twelve patients had RBO (71 %), including 9 stent occlusions due to sludge and 3 stent migrations. The median TRBO was 79 days (IQR: 58 – 156 days) during the follow-up period (median 192 days [IQR: 88 – 551 days]). The median TRBO of patients with Bismuth type II lesions was significantly longer than that of patients with Bismuth types III and IV lesions (87 days [IQR: 70 – 244 days] vs. 54 days [IQR: 35 – 100 days]; P  = 0.030). Thirteen patients (76 %) required endoscopic reintervention. Endoscopic stent removal was possible in 6 patients without tumor ingrowth into the uncovered distal part of the stent. One late adverse event (≥ 31 days) occurred (cholangitis). Conclusions Endoscopic SBS placement of a PCSEMS was feasible in patients with unresectable MHBO. Additionally, reinterventional stent removal was possible in the absence of tumor ingrowth.

Mo1287 Impact of Endoscopic Biliary Drainage on Quality of Life in Patients With Unresectable Malignant Biliary Obstruction

2012 ◽  
Vol 75 (4) ◽  
pp. AB376
Author(s):  
Yukiko Ito ◽  
Hiroyuki Isayama ◽  
Takeshi Tsujino ◽  
Takashi Sasaki ◽  
Hirofumi Kogure ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Malignant Biliary Obstruction ◽  
Endoscopic Biliary Drainage

Percutaneous transhepatic drainage in obstructive jaundice: Advantages and problems

1982 ◽  
Vol 69 (5) ◽  
pp. 261-264 ◽  
Author(s):  
G. A. D. McPherson ◽  
I. S. Benjamin ◽  
N. A. Habib ◽  
N. B. Bowley ◽  
L. H. Blumgart
Keyword(s):  
Obstructive Jaundice ◽  
Percutaneous Transhepatic Drainage ◽  
Transhepatic Drainage

scholarly journals Pregnancy and dialysis

2020 ◽  
Vol 42 (3) ◽  
pp. 349-356
Author(s):  
Catarina Isabel Ribeiro ◽  
Natália Silva
Keyword(s):  
Pregnant Women ◽  
Multidisciplinary Approach ◽  
Treatment Options ◽  
Success Rates ◽  
Basic Principles ◽  
Future Challenges ◽  
Fetal Complications ◽  
Literature Evidence ◽  
Low Levels ◽  
Nutritional Deficits

ABSTRACT The pregnancy rate of women on dialysis is still very low when compared to that of the remaining population. However, recent years have seen an increase in the success rates of these pregnancies. Among the main precautions that must be taken with pregnant women on dialysis are the maintenance of low levels of pre-dialysis urea, the adequacy of the tension profile, the control of anemia and care to avoid infections, nutritional deficits, changes in phosphorus-calcium metabolism and electrolytic fluctuations. It is also necessary to strictly monitor fetal growth and development. Pregnant women on dialysis have a higher probability of maternal and fetal complications; thus the importance of a multidisciplinary approach among nephrologists, obstetricians and pediatricians. The main objective of this study was to review the literature evidence available on pregnancy on dialysis, on the basic principles of the pathophysiology of pregnant women and their particularities in kidney disease. We will address available treatment options, benefits and risks, anticipating possible future challenges. At the end, we will present a clinical case to illustrate the topic.

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