Use of articulated catheters in the treatment of biliary strictures

Abstract

We have used a single articulated catheter to obviate the need for multiple catheters in patients with complex biliary strictures or strictures associated with small or immature tracts. Two- and three-arm articulated drains (8-14 Fr) made from segments of biliary catheters were placed in 16 patients. Nine were placed transhepatically, 6 transperitoneally through existing T-tube tracts, and 1 through a cystic duct fistula. Six malignant and 10 benign strictures were stented with various catheter configurations through a single tract. Fifteen patients had two catheter components with one articulation and 1 patient had three catheter components with two articulations. The average duration of catheter drainage was 7.0 +/- 4.2 months. Routine catheter exchanges were performed; two spontaneous occlusions occurred. In patients where internal stenting may be difficult or undesirable, articulated catheters allow satisfactory external and internal drainage of complex benign and malignant strictures through a single tract, avoiding the need for multiple transhepatic catheters.

Complex percutaneous biliary procedures: Review and contributions of a high volume team

“…Therefore more punctures and consequently more bleeding risk as we could establish in a prospective study of 150 cases of PBDs; number of punctures (threshold set in > 5): the odds ratio (OR) was 2.8495 (95% confidence interval [CI], 1.0771-7.5389) and number of drains (threshold set in > 2): OR was 4.1282 (95% CI, 1.4234-11.9730) (Houghton EJ et al; unpublished data). Therefore, Shlansky-Goldberg et al 35 described a technique that solves the equation without increasing the risk called articulated catheters.…”

Articulated percutaneous plastic biliary stents: How to do it

“…Removing the stents is usually straightforward, but although the contralateral access is momentarily lost, recovering access is relatively simple. 12 Steps to Articulate Plastic Stents In most cases, the patient already has a PTBD catheter in place. Although placing APBS de novo is possible, the manipulation of the fresh liver parenchyma tract can be associated with bleeding, bile leak and is usually painful, and therefore, most frequently, the APBS is delayed for 2 to 3 weeks after initial PTBD placement.…”

“…Stent occlusion is possible but rare and easily resolved by changing the stent. 12 Hemobilia and cholangitis are also possible ( Fig. 13).…”

“…ABPS were originally described for the replacement of biliary T tubes as early as 1990. 10,11 In 1997, Shlansky-Goldberg et al 12 described the use of the ABPS in anastomotic and hilar lesions in 16 patients with benign or malignant biliary strictures for an average duration of 7 months. A variation of the technique de-scribed originally by Tsai et al 13 uses a dual catheter technique where a smaller 10 Fr.…”