Percutaneous transhepatic insertion of a permanent endoprosthesis in obstructive lesions of the extrahepatic bile ducts

Abstract

A Teflon endoprosthesis for permanent bile drainage was inserted in 13 patients following percutaneous transhepatic puncture and catheterization of the bile duct system. Twelve patients had extrahepatic cholestasis because of a malignant tumor, whereas one patient had chronic inflammation involving the hepatoduodenal ligament (secondary to Crohn's disease) with obstruction of the extrahepatic bile ducts. The drainage periods varied from 1 week to 8 months. The endoprosthesis was regarded as partially effective in seven patients whereas in six cases the drainage through the endoprosthesis was insufficient and external bile drainage through a percutaneous transhepatic catheter was necessary. Infection of the bile duct system during the drainage period with a percutaneous transhepatic catheter and/or bile duct endoprosthesis occurred in 10 patients. Spontaneous dislocation of the endoprosthesis occurred in varying degrees in five patients. One patient developed an intrahepatic aneurysm adjacent to the puncture tract and died because of liver insufficiency following therapeutic embolization of the aneurysm and most of the hepatic arteries by injection of gelfoam particles into the common hepatic artery. Patients in whom palliative treatment by insertion of a permanent bile duct endoprosthesis may be suitable were defined.

A New Exchangeable Long Biliary Endoprosthesis for Percutaneous Transhepatic Internal Drainage

“…We have found this endoprosthesis to be easier to remove than the device reported by Miskowiak et al 16) , a subcutaneous button connected by a transhepatic suture to the biliary endoprosthesis. The advantages of our new long endoprosthesis with its inserted proximal end button are its stability of position due to its length and its ease of removal through a small skin incision.…”

Surgical treatment for patients with advanced pancreatic cancer

“…In recent years, nonoperative palliation of jaundice has become available in patients with malignant biliary obstruction 30,31. Four prospective studies have compared surgical bypass procedures with nonoperative stenting .…”

Parasitic and mycotic causes of biliary obstruction

“…Small worms were seen on aspirated bile during cholangiography. A permanent endoprosthesis for internal drainage of the biliary tract was inserted using the transhepatic approach recently described [6], followed by satisfactory decompression and relief of the obstructive jaundice ( Fig. 1 C and D).…”

“…However, surgical relief of obstruction is the treatment of choice, and the endoprosthesis is an alternate method. The technique of endoprosthesis insertion has been described elsewhere [6].…”