Percutaneous transhepatic biliary stenting: The first experience and results of the Hospital of Kaunas University of Medicine

Dambrauskas, Žilvinas; Paškauskas, Saulius; Lizdenis, Paulius; Uktveris, Rimantas; Pranculis, Andrius; Kaupas, Rytis Stasys; Barauskas, Giedrius; Pundzius, Juozas

doi:10.3390/medicina44120121

Cited by 15 publications

(15 citation statements)

References 24 publications

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“…For example, a higher risk of complications following the bilateral approach has been reported, and some authors advocate that this risk should not be taken as even 30% of functional liver parenchyma could be sufficient [1][2][3][4][5][6][20][21][22][23][24][25] . Nonetheless, although no control group was available, the authors support the notion that in the specific population of end-stage, advanced, hilar disease, bilateral decompression was vital for the clinical success and survival rates achieved.…”

Section: Discussionmentioning

confidence: 99%

“…The most common causes of this condition are cholangiocarcinoma, gallbladder cancer and pancreatic carcinoma [1] . Although surgery is indicated in many cases for the management of malignant biliary obstruction, nearly 80% of the patients are inoperable by the time of diagnosis and the median survival ranges between 3 and 10 mo [2][3][4] . Minimally invasive decompression drainage modalities are established palliative methods for the management of inoperable hilar lesions and include percutaneous trans-hepatic biliary drainage, endoscopic stricture stenting and percutaneous trans-hepatic biliary stenting (PTBS) [4][5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

“…Although surgery is indicated in many cases for the management of malignant biliary obstruction, nearly 80% of the patients are inoperable by the time of diagnosis and the median survival ranges between 3 and 10 mo [2][3][4] . Minimally invasive decompression drainage modalities are established palliative methods for the management of inoperable hilar lesions and include percutaneous trans-hepatic biliary drainage, endoscopic stricture stenting and percutaneous trans-hepatic biliary stenting (PTBS) [4][5][6][7] . Malignant obstructions of the hepatic hilum are characterized by extremely poor prognosis resulting in a 5-year survival rate around 5%, and are also the most technically challenging biliary lesions for both endoscopic and interventional radiology management approaches [2] .…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous trans-hepatic bilateral biliary stenting in Bismuth IV malignant obstruction

Karnabatidis

Spiliοpoulos²,

Katsakiori³

et al. 2013

WJH

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AIM:To investigate the clinical efficiency of percutaneous trans-hepatic bilateral biliary metallic stenting for the management of Bismuth Ⅳ malignant obstructive disease. METHODS:Our hospital's database was searched for all patients suffering from the inoperable malignant biliary obstruction Bismuth Ⅳ, and treated with percutaneous bilateral trans-hepatic placement of selfexpandable nitinol stents. The indication for percutaneous stenting was an inoperable, malignant, symptomatic, biliary obstruction. An un-correctable coagulation disorder was the only absolute contra-indication for treatment. Bismuth grading was performed using magnetic resonance cholangiopancreatography. Computed tomography evaluation of the lesion and the dilatation status of the biliary tree was always performed prior to the procedure. All procedures were performed under conscious sedation. A single trans-hepatic track technique was preferred (T-configuration stenting) and a second, contra-lateral trans-hepatic track (Y-configuration stenting) was used only in cases of inability to access the contra-lateral lobe using a single track technique. The study's primary endpoints were clinical success, defined as a decrease in bilirubin levels within 10 d and patient survival rates. Secondary endpoints included peri-procedural complications, primary and secondary patency rates. RESULTS:A total of 35 patients (18 female, 51.4%) with a mean age 69 ± 13 years (range 33-88) were included in the study. The procedures were performed between March 2000 and June 2008 and mean time follow-up was 13.5 ± 22.0 mo (range 0-96). The underlying malignant disease was cholangiocarcinoma (n = 10), hepatocellular carcinoma (n = 9), pancreatic carcinoma (n = 5), gastric cancer (n = 2), bile duct tumor (n = 2), colorectal cancer (n = 2), gallbladder carcinoma (n = 2), lung cancer (n = 1), breast cancer (n = 1) or non-Hodgkin lymphoma (n = 1). In all cases, various self-expandable bare metal stents with diameters ranging from 7 to 10 mm were used. Stents were placed in Y-configuration in 24/35 cases (68.6%) using two stents in 12/24 patients and three stents in 12/24 cases (50%). A T-configuration stent placement was performed in 11/35 patients (31.4%), using two stents in 4/11 cases (36.4%) and three stents in 7/11 cases (63.6%). Follow-up was available in all patients (35/35). Patient survival ranged from 0 to 1763 d and the mean survival time was 168 d. Clinical success rate was 77.1% (27/35 cases), and peri-procedural mortality rate was 5.7% (2/35 patients). Biliary reobstruction due to stent occlusion occurred in 25.7% of the cases (9/35 patients), while in 7/11 (63.6%) one additional percutaneous re-intervention due to stent occlusion resulting in clinical relapse of symptomatology was successfully performed. In the remaining Karnabatidis D et al . Percutaneous bilateral biliary stenting 4/11 patients (36.4%) more than 1 additional reintervention was performed. The median decrease of total serum bilirubin was 60.5% and occurred in 81.8% of the cases (27/...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Percutaneous trans-hepatic bilateral biliary stenting in Bismuth IV malignant obstruction

Karnabatidis

Spiliοpoulos²,

Katsakiori³

et al. 2013

WJH

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“…Percutaneous transhepatic biliary drainage is becoming more and more useful as a palliative treatment for patients with malignant obstructive jaundice, which could not only significantly reduce bilirubin levels, improve liver function and prolong survival time, but also be used as a preoperative drainage, provide conditions for subsequent treatment (Dambraukas et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

Internal-External Percutaneous Transhepatic Biliary Drainage for Patients with Malignant Obstructive Jaundice

Xu¹,

Lv²,

Huang³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Asian Pac J Cancer Prev, 15 (21), 9391-9394 IntroductionPercutaneous transhepatic biliary drainage is becoming more and more useful as a palliative treatment for patients with malignant obstructive jaundice, which could not only significantly reduce bilirubin levels, improve liver function and prolong survival time, but also be used as a preoperative drainage, provide the conditions for subsequent treatment (Boursier et al., 2009;Herzog et al., 2012;Kaya et al., 2012;Zhu et al., 2012). In our center, if the guide wire could pass through the occlusion and into the duodenum, we prefer to use internal-external drainage, while the occlusion is not crossed, external drainage biliary catheter is placed. We think that internal-external drainage in the treatment of malignant obstructive jaundice not only could lead bile flow into intestine, maintain the physical channel of bile drainage, also decline bilirubin level quickly which is beneficial to the recovery of liver function and reduce the gastrointestinal complications caused by lack of bile. In order to evaluate the efficacy of this kind of treatment, we collect patients with malignant obstructive jaundice receiving this procedure in 2008-2013.

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“…Infection is one of the most common complication in patients with obstructive jaundice, which could lead to death perioperation (He et al, 2002;Dambraukas et al, 2003). In previous report, the incidence of infection after stenting is 6.5% -22% ( Shin et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Analysis of Different Ways of Drainage for Obstructive Jaundice Caused by Hilar Cholangiocarcinoma

Xu¹,

Lv²,

Huang³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Objective: To evaluate the prognosis of different ways of drainage for patients with obstructive jaundice caused by hilar cholangiocarcinoma. Materials and Methods: During the period of January 2006-March 2012, percutaneous transhepatic catheter drainage (PTCD)/ percutaneous transhepatic biliary stenting (PTBS) were performed for 89 patients. According to percutaneous transhepatic cholangiography (PTC), external drainage was selected if the region of obstruction could not be passed by guide wire or a metallic stent was inserted if it could. External drainage was the first choice if infection was diagnosed before the procedure, and a metallic stent was inserted in one week after the infection was under control. Selection by new infections, the degree of bilirubin decrease, the change of ALT, the time of recurrence of obstruction, and the survival time of patients as the parameters was conducted to evaluate the methods of different interventional treatments regarding prognosis of patients with hilar obstruction caused by hilar cholangiocarcinoma. Results: PTCD was conducted in 6 patients and PTBS in 7 (p<0.05). Reduction of bilirubin levels and ALT levels was obvious after the procedures (p<0.05). The average survival time with PTCD was 161 days and with PTBS was 243 days (p<0.05). Conclusions: With both drainage procedures for obstructive jaundice caused by hilar cholangiocarcinoma improvement in liver function was obvious. PTBS was found to be better than PTCD for prolonging the patient survival.

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Percutaneous transhepatic biliary stenting: The first experience and results of the Hospital of Kaunas University of Medicine

Cited by 15 publications

References 24 publications

Percutaneous trans-hepatic bilateral biliary stenting in Bismuth IV malignant obstruction

Percutaneous trans-hepatic bilateral biliary stenting in Bismuth IV malignant obstruction

Internal-External Percutaneous Transhepatic Biliary Drainage for Patients with Malignant Obstructive Jaundice

Analysis of Different Ways of Drainage for Obstructive Jaundice Caused by Hilar Cholangiocarcinoma

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