Percutaneous Treatment of Benign Biliary Strictures and Biliary Manometric Perfusion Test

Abstract

Background: Benign biliary strictures are usually treated surgically or endoscopically. When these strictures are not accessible by endoscope or when open repair is not possible, percutaneous dilatation treatment is indicated. The effi cacy of treatment is usually evaluated by clinical trial which includes leaving a small non-functional catheter in situ and following liver function tests. The evaluation may be eff ectively done by the biliary manometric perfusion test.Aim: The aim of this paper is to emphasize the importance of percutaneous dilatation treatment of benign biliary strictures with focus on the role of the biliary manometric perfusion test and its future prospects.Methods and Results: Based on the literature and our own experience, this article gives a short overview of percutaneous treatment of benign biliary strictures, indications, techniques, complications and results. The treatment of these strictures has an overall success rate between 60 to 90 %. This article also explains the biliary manometric test, the technique and its importance in evaluation of treatment success.Conclusion: Benign biliary strictures of the hepatic duct junction or bilio-enteric anastomosis are diffi cult to treat surgically and are endoscopically inaccessible. Percutaneous treatment by balloon dilatation and long term externalinternal drainage is feasible in the majority of these patients. It is minimally invasive, safe and eff ective. The evaluation of the treatment success may be more eff ectively done by the manometric perfusion test. It is easy, reliable, less time-consuming giving immediate results, and relatively safe.

Biliary Manometric Perfusion Test in the Evaluation of Benign Biliary Stricture Treatment - A Case Report

“…The methodology of the perfusion test was as described above and we followed the specifi cally reported technique by Savader et al [2][3][4] . There are very few studies that measure biliary pressure to evaluate treatment.…”

“…We evaluated the treatment effi cacy and success of the treatment using the biliary manometric perfusion test(BMPT) instead of the standard clinical test. We followed the specifi cally reported technique of manometric perfusion test by Savader et al [2][3][4] . The pre-exisiting internal external biliary catheter was exchanged for a 10 F sheath which was left peripheral to the treated stenosis (Fig.…”

Is the Biliary Manometric Perfusion Test Effective in the Evaluation of Balloon Dilatation Treatment Success of Benign Biliary Strictures?

“…Indications for hepaticojejunostomy were injury to bile ducts during laproscopic cholecystectomy in 9 patients, duodenopancreatectomy in 2 patients and resection of benign tumor in one patient. Six patients had symptoms of obstructive jaundice or obstructive jaundice and cholangitis, two patients had symp-R. P. Thomas After the initial transhepatic drainage, balloon dilatation and long term external internal drainage had been done for all patients according to the methodology percutaneous dilatation treatment described in literature 1,5,6 . Subsequently follow-up cholangiography usually after 6 months was performed.…”

“…1). We followed the specifically reported and validated technique of Savader et al [5][6][7][8] . The preexisting internal external biliary catheter was exchanged for a 9 or 10 F sheath which was left peripheral to the treated stenosis and was connected by tubing and a three way stop cock to a manometer and a standard angiography injector.…”

“…If all the pressure values during the perfusion test were less than 20 cm of water, the drain was removed and the patients were discharged. If pressure values were more than 20 cm of water, additional intervention was done by balloon dilatation and long term drainage for another 3 months 5,6 . Patients were followed up by gastroenterologists or surgeons for any symptoms of biliary obstruction.…”