1
|
Nunes TF, Santos RFT, Tibana TK, Szejnfeld D. Percutaneous transhepatic approach to endoscopic placement of a 10F plastic biliary stent: step-by-step description of a novel technique. Radiol Bras 2020; 53:281-283. [PMID: 32904890 PMCID: PMC7458555 DOI: 10.1590/0100-3984.2019.0116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Thiago Franchi Nunes
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | | | - Tiago Kojun Tibana
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Denis Szejnfeld
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| |
Collapse
|
2
|
Abstract
Expandable metal stents (20 Gianturco Z-stents and 1 Strecker stent deployed through 8.5 F sheaths) were used with initial success for palliating bile duct obstruction in 10 patients, 8 with malignant and 2 with benign strictures. Short-term failure occurred in one patient after 2 weeks, one died of unrelated causes after 10 days, and one remained jaundiced due to fulminant liver metastases. In the remaining 7 patients the obstruction was markedly palliated, with normalization of the serum bilirubin. Four have died without recurrent bile duct obstruction after a mean of 5.9 months, the 2 with benign strictures are well after 4 and 7 months, and one patient is presently palliated with a plastic endoprosthesis following reocclusion after 4 months. Expandable stents were easier to insert than conventional percutaneous endoprostheses of plastic polymers, and had longer patency in several patients, but reocclusion by tumor growth remains a constant threat in malignant disease. Metallic stents may be the therapy of choice in recurrent benign strictures, although the definitive conclusion needs longer observation and larger materials.
Collapse
|
3
|
Abstract
Endoscopic biliary plastic stent placement is a well-established technique for unresectable and recurrent biliary obstructive disease and provides significant improvement in the quality of life. We describe a new technique of percutaneous placement of biliary plastic stent that has not been previously mentioned in the literature.
Collapse
Affiliation(s)
- Shyamkumar N Keshava
- Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
| | | |
Collapse
|
4
|
YOSHIOKA T, SAKAGUCHI H, UCHIDA H. Biliary Stenting by the Transhepatic Approach. Dig Endosc 2007. [DOI: 10.1111/j.1443-1661.1999.tb00003.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
| | | | - Hideo UCHIDA
- Department of Radiology, Nara Medical University, Nara, Japan
| |
Collapse
|
5
|
Kim DH, Kang SG, Choi JR, Byun JN, Kim YC, Ahn YM. Evaluation of the biodurability of polyurethane-covered stent using a flow phantom. Korean J Radiol 2001; 2:75-9. [PMID: 11752974 PMCID: PMC2718105 DOI: 10.3348/kjr.2001.2.2.75] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the biodurability of the covering material in retrievable metallic stents covered with polycarbonate polyurethane. MATERIALS AND METHODS Using a peristaltic pump at a constant rate of 1 ml/min, bile was recirculated from a reservoir through a long tube containing four stents. Each of these was removed from the system every two weeks and a radial tensile strength test and scanning electron microscopy (SEM) were performed. Each stent, removed at 2, 4, 6 and 8 weeks, was compared with a control stent not exposed to bile juice. RESULTS Gross examination showed that stents were intact at 2 weeks, but at 4, 6 and 8 weeks cracks were observed. The size of these increased gradually in accordance with the duration of exposure, and at 8 weeks several large holes in the polyurethane membrane were evident. With regard to radial tensile strength, extension and peak load at break were 84.47% and 10.030 N/mm, 54.90% and 6.769 N/mm, 16.55% and 2.452 N/mm, 11.21% and 1.373 N/mm at 0, 2, 4 and 6 weeks, respectively. Scanning electron microscopy at 2 weeks revealed intermittent pitting and cracking, and examination at 4, 6 and 8 weeks showed that the size of these defects was gradually increasing. CONCLUSION When the polyurethane membrane was exposed to bile, biodegradation was first observed at week two and increased gradually according to the duration of exposure.
Collapse
Affiliation(s)
- Dong Hyun Kim
- Department of Diagnostic Radiology, Chosun University Hospital, Korea
| | - Sung-Gwon Kang
- Department of Diagnostic Radiology, Chosun University Hospital, Korea
| | - Jung Ryul Choi
- Department of Diagnostic Radiology, Chosun University Hospital, Korea
| | - Ju Nam Byun
- Department of Diagnostic Radiology, Chosun University Hospital, Korea
| | - Young Chul Kim
- Department of Diagnostic Radiology, Chosun University Hospital, Korea
| | - Young Moo Ahn
- Department of Clothing and Textiles, Hansung University, Korea
| |
Collapse
|
6
|
Ernst O, Sergent G, Mizrahi D, Delemazure O, L'Herminé C. Biliary leaks: treatment by means of percutaneous transhepatic biliary drainage. Radiology 1999; 211:345-8. [PMID: 10228512 DOI: 10.1148/radiology.211.2.r99ma30345] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the efficacy of percutaneous transhepatic biliary drainage in the treatment of biliary leaks. MATERIALS AND METHODS Sixteen patients with a biliary leak involving either the common bile duct (n = 12), the biliary confluence (n = 2), or a hepaticojejunal anastomosis (n = 2) were treated by means of percutaneous transhepatic biliary drainage. The biliary leak was due to severe acute necrotizing pancreatitis in six patients, while 10 patients had postoperative leak. Percutaneous transhepatic biliary drainage was performed with a 12-F catheter, with two series of side holes positioned on both sides of the extravasation to divert bile flow away from the defect. RESULTS In 13 patients, the biliary leak healed after drainage (mean duration, 78 days). In four of these patients, a slight residual narrowing of the bile duct was treated by means of either balloon dilation (n = 2) or balloon dilation followed by insertion of a metallic stent (n = 2). All 13 patients remained cured (mean follow-up, 38 months). Two patients with severe acute necrotizing pancreatitis died of complications unrelated to the biliary leak. Vascular complications occurred in two patients, one of whom died after surgical drainage of a subcapsular hematoma. CONCLUSION Biliary leaks can be treated successfully by means of percutaneous transhepatic biliary drainage. The procedure is particularly useful when surgical or endoscopic management has failed.
Collapse
Affiliation(s)
- O Ernst
- Department of Radiology, Centre Hospitalier Universitaire de Lille, France
| | | | | | | | | |
Collapse
|
7
|
Affiliation(s)
- S M Wu
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
| | | | | |
Collapse
|
8
|
|
9
|
L'Hermine C, Ernst O, Delemazure O, Sergent G. Arterial complications of percutaneous transhepatic biliary drainage. Cardiovasc Intervent Radiol 1996; 19:160-4. [PMID: 8661642 DOI: 10.1007/bf02577612] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To report on the frequency and treatment of arterial complications due to percutaneous transhepatic biliary drainage (PTBD). MATERIALS Lesions of the intrahepatic artery were encountered in 10 of 525 patients treated by PTBD (2%). Hemobilia followed in 9 patients and subcapsular hematoma in 1. Seven patients had a benign biliary stenosis and 3 had a malignant stenosis. RESULTS The bleeding resolved spontaneously in 3 patients. In 7 it required arterial embolization, which was successfully achieved either through the percutaneous catheter (n = 3) or by arteriography (n = 4). CONCLUSION Arterial bleeding is a relatively rare complication of PTBD that can easily be treated by selective arterial embolization when it does not resolve spontaneously. In this series its frequency was much higher (16%) when the stenosis was benign than when it was malignant (0.6%).
Collapse
Affiliation(s)
- C L'Hermine
- Department of Radiology, Hospital Claude Huriez, Place de Verdun, F-59037 Lille Cedex, France
| | | | | | | |
Collapse
|
10
|
Petersen BD, Maxfield SR, Ivancev K, Uchida BT, Rabkin JM, Rösch J. Biliary strictures in hepatic transplantation: treatment with self-expanding Z stents. J Vasc Interv Radiol 1996; 7:221-8. [PMID: 9007801 DOI: 10.1016/s1051-0443(96)70765-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To determine the long-term results of Gianturco-Rösch Z (GRZ) stent placement for the treatment of recurrent, benign biliary strictures in liver transplant recipients. MATERIALS AND METHODS During a 5-year period, eight orthotopic liver transplant recipients underwent transhepatic placement of GRZ stents to treat 12 recurrent biliary strictures (six anastomotic, six intrahepatic). Prior treatment of 11 strictures with balloon dilation therapy had failed. Patients were followed up for 1-65 months. RESULTS Stent placement was successful in all patients. Stent position remained stable in all but one patient. Three patients died (1, 25, and 28 months after stent placement), all with patent stents. Four patients required no further biliary intervention. Two of the other four patients needed intermittent biliary balloon dilation with removal of bile duct debris. The third patient had a stable, nonobstructing stenosis in the stent. The fourth passed his stents and needed no further intervention. CONCLUSION GRZ stents are useful in patients who are refractory to repetitive balloon dilation of biliary strictures or who are poor surgical candidates.
Collapse
Affiliation(s)
- B D Petersen
- Dotter Interventional Institute, Oregon Health Sciences University, Portland 97201, USA
| | | | | | | | | | | |
Collapse
|
11
|
Bezzi M, Silecchia G, Orsi F, Materia A, Salvatori FM, Fiocca F, Fantini A, Basso N, Rossi P. Complications after laparoscopic cholecystectomy. Coordinated radiologic, endoscopic, and surgical treatment. Surg Endosc 1995; 9:29-36. [PMID: 7725210 DOI: 10.1007/bf00187881] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The diagnostic and therapeutic approaches used for patients referred for bile duct injuries and other major complications after laparoscopic cholecystectomy (LC) were reviewed and the results of a coordinated radiologic, endoscopic, and surgical approach were assessed. From April 1991 to October 1993, 23 patients were observed. Seven patients had biliary strictures, five had biliary lesions, five presented with retained common bile duct (CBD) stones, and one had a minor cystic duct leak. Five patients had miscellaneous abdominal fluid collections; in addition, biloma or bile ascites were present in 10/23 cases. Correct definition of iatrogenic lesions was mainly made by endoscopic retrograde cholangiography (ERCP) (n = 15), associated in six cases also with percutaneous cholangiography (PTC). "Minimally invasive" treatment included the full range of endoscopic and interventional radiological procedures. Six patients with biliary strictures, one patient with a biliary lesion, all five patients with residual CBD stones, and four patients with abdominal collections were treated by "minimally invasive" techniques: Therefore, laparotomy was avoided in 70% of cases (16/23 patients). Open surgery was necessary in 7/23 patients (30%), because of ductal lesion (n = 4), ductal stricture by endoloop (n = 1), iliac artery injury (n = 1), and phlegmon of gallbladder bed (n = 1). It appears that careful assessment of complications after LC is mandatory and often requires the combined use of ERCP/PTC and cross-sectional imaging.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- M Bezzi
- Department of Radiology, University of Rome La Sapienza, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Vorwerk D, Kissinger G, Handt S, Günther RW. Long-term patency of Wallstent endoprostheses in benign biliary obstructions: experimental results. J Vasc Interv Radiol 1993; 4:625-34. [PMID: 8219557 DOI: 10.1016/s1051-0443(93)71936-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Coated and noncoated Wallstents were implanted in dogs with experimental benign common bile duct stenoses to monitor the long-term patency of self-expanding stents in the biliary system. MATERIALS AND METHODS Experimental common bile duct stenoses were induced with a thermal laser in 12 dogs. Three silicone-coated and 14 noncoated stents were implanted. The animals were followed up from 3 to 25 months by means of cholangiography, cholangioscopy, measurements of liver enzyme levels, autopsy, and histology. RESULTS Silicone coated stents failed in all cases, resulting in two total occlusions and one stent dislodgment to the bowel. Noncoated stents led to marked mucosal hyperplasia and stent narrowing in most cases, but with follow-up of more than 12 months, hyperplasia underwent regression and--except in one case--neither an increase in liver enzyme levels nor stent occlusion occurred. Histologically, the extent of hyperplasia was related to the stent position within the duct wall. With stents in the mucosal layer, hyperplasia was excessive. Once the stent entered the submucosal layer, hyperplasia was decreased. CONCLUSION In an experimental setting, mucosal hyperplasia did not compromise patency of noncoated stents in benign bile duct stenosis and regressed with late follow-up after 12 months.
Collapse
Affiliation(s)
- D Vorwerk
- Department of Radiology, Technical University of Aachen, Germany
| | | | | | | |
Collapse
|
13
|
Raute M, Podlech P, Jaschke W, Manegold BC, Trede M, Chir B. Management of bile duct injuries and strictures following cholecystectomy. World J Surg 1993; 17:553-62. [PMID: 8362535 DOI: 10.1007/bf01655124] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
During 7057 conventional cholecystectomies (1972-1991), 16 bile duct injuries occurred, amounting to a risk of 0.22%. A total of 1022 laparoscopic cholecystectomies were performed without such a complication since April 1990. In a retrospective study, 64 patients (16 of our patients and 48 referrals) with an injury or stricture due to conventional cholecystectomy were investigated. In 14 of our 16 patients the injury was recognized and immediately repaired with a good long-term result of 93%, including one successful repair of a subsequent stricture. Two cases of unrecognized injury were managed by nonoperative means. The group of 48 referred patients comprised 10 early postoperative complications (21%) and 38 strictures after an "uneventful" cholecystectomy. Of the 64 total patients, 10 (16%) underwent nonoperative treatment, and 54 required surgery. The mean follow-up period after surgery was 7.4 +/- 4.9 years. Most cases (93%) were repaired by bilioenteric anastomosis (i.e., foremost hepaticojejunostomy) with an 18% restricture rate. Including second and third repairs for restricture, a total of 60 operations (14 primary and 46 secondary reconstructions) were performed without hospital mortality. A good long-term result after stricture repair was achieved in 75% of the patients, whereas 17% had a poor outcome owing to restricture or death (10% had related mortality within 10 years). The other 8% had a moderate result due to recurrent cholangitis. Thus immediate repair of a bile duct injury offers the better chance of a favorable prognosis compared to secondary stricture repair.
Collapse
Affiliation(s)
- M Raute
- Department of Surgery, Mannheim Clinic of Heidelberg University, Germany
| | | | | | | | | | | |
Collapse
|
14
|
Maccioni F, Rossi M, Salvatori FM, Ricci P, Bezzi M, Rossi P. Metallic stents in benign biliary strictures: three-year follow-up. Cardiovasc Intervent Radiol 1992; 15:360-6. [PMID: 1477861 DOI: 10.1007/bf02734119] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Eighteen patients with recurrent benign biliary strictures (BBS) were selected for metallic stents placement because they failed to respond to percutaneous balloon dilatation. None were candidates for surgical corrections. We used "Z" single or double stents in 17 cases and a Wallstent in 1 case. After more than 3 years of follow-up (average period 37 months, range 30-41 months), 10 patients (55.5%) were asymptomatic without signs of bile stasis; 5 patients (27.7%) had recurrence of symptoms and were eventually retreated; and 3 patients (16.6%) died, 2 of obstructive jaundice and liver failure and 1 of metastatic gastric cancer. Recurrence was due to stent occlusion by tissue ingrowth in 3 cases, stent migration in 1 case, and an inflammatory lesion of the papilla of Vater in another case, with patency of the metallic stent. The overall patency rate, at 3-year follow-up was 68.7%. In our series, the main factor determining long-term patency of metallic stents has been reactive tissue ingrowth. Nevertheless, long-term results obtained with metallic stents in recurrent benign biliary strictures should be considered satisfactory. In selected patients, metallic stents may represent the only long-term treatment available for maintaining bile flow.
Collapse
Affiliation(s)
- F Maccioni
- 4a Cattedra di Radiologia, Università La Sapienza, Rome, Italy
| | | | | | | | | | | |
Collapse
|