Efficacy of multiple biliary stenting for refractory benign biliary strictures due to chronic calcifying pancreatitis

The practice of systematic examinations in hospitals and the increasing development of automatic data processing permits the storing of a great deal of information about a large number of patients belonging to different diagnosis groups.To predict or to characterize these diagnosis groups some descriptors are particularly useful, others carry no information. Data screening based on the properties of mutual information and on the log cross products ratios in contingency tables is developed. The most useful descriptors are selected. For each one the characterized groups are specified.This approach has been performed on a set of binary (presence—absence) radiological variables. Four diagnoses groups are concerned: cancer of pancreas, chronic calcifying pancreatitis, non-calcifying pancreatitis and probable pancreatitis. Only twenty of the three hundred and forty initial radiological variables are selected. The presence of each corresponding sign is associated with one or more diagnosis groups.

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Endoscopic treatment of benign biliary strictures with self-expandable metal stent

Zeitschrift für Gastroenterologie ◽

10.1055/s-2005-869748 ◽

2005 ◽

Vol 43 (05) ◽

Author(s):

T Pintér ◽

J Pozsár ◽

P Sahin ◽

F László ◽

L Topa

Keyword(s):

Endoscopic Treatment ◽

Metal Stent ◽

Biliary Strictures ◽

Benign Biliary Strictures ◽

Self Expandable Metal Stent

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Extraluminal recanalization for postoperative biliary obstruction using transseptal needle

Surgical Case Reports ◽

10.1186/s40792-020-01080-9 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Hiroki Horinouchi ◽

Eisuke Ueshima ◽

Keitaro Sofue ◽

Shohei Komatsu ◽

Takuya Okada ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Bile Duct ◽

Biliary Obstruction ◽

Hepatic Duct ◽

Drainage Tube ◽

Biliary Strictures ◽

Hepatic Bile ◽

Hepatic Bile Duct ◽

Benign Biliary Strictures ◽

The Right

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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