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Oh CH, Gwon DI, Chu HH, Ko GY, Kim GH, Choi SL, Kim SW. Percutaneous insertion of long-covered biliary stents in patients with malignant duodenobiliary stricture. Eur Radiol 2024; 34:538-547. [PMID: 37540317 DOI: 10.1007/s00330-023-10024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To investigate the technical feasibility, safety, and efficacy of a long-covered biliary stent in patients with malignant duodenobiliary stricture. METHODS This retrospective study enrolled 57 consecutive patients (34 men, 23 women; mean age, 64 years; range, 32-85 years) who presented with malignant duodenobiliary stricture between February 2019 and November 2020. All patients were treated with a long (18 or 23 cm)-covered biliary stent. RESULTS The biliary stent deployment was technically successful in all 57 patients. The overall adverse event rate was 17.5% (10 of 57 patients). Successful internal drainage was achieved in 55 (96.5%) of 57 patients. The median patient survival and stent patency times were 99 days (95% confidence interval [CI], 58-140 days) and 73 days (95% CI, 60-86 days), respectively. Fourteen (25.5%) of the fifty-five patients presented with biliary stent dysfunction due to sludge (n = 11), tumor overgrowth (n = 1), collapse of the long biliary stent by a subsequently inserted additional duodenal stent (n = 1), or rapidly progressed duodenal cancer (n = 1). A univariate Cox proportional hazards model did not reveal any independent predictor of biliary stent patency. CONCLUSIONS Percutaneous insertion of a subsequent biliary stent was technically feasible after duodenal stent insertion. Percutaneous insertion of a long-covered biliary stent was safe and effective in patients with malignant duodenobiliary stricture. CLINICAL RELEVANCE STATEMENT In patients with malignant duodenobiliary stricture, percutaneous insertion of a long-covered biliary stent was safe and effective regardless of duodenal stent placement. KEY POINTS • Percutaneous insertion of long-covered biliary stents in patients with malignant duodenobiliary stricture is a safe and effective procedure. • Biliary stent deployment was technically successful in all 57 patients and successful internal drainage was achieved in 55 (96.5%) of 57 patients. • The median patient survival and stent patency times were 99 days and 73 days, respectively, after placement of a long-covered biliary stent in patients with duodenobiliary stricture.
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Affiliation(s)
- Chang Hoon Oh
- Department of Radiology, Ewha Womans Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea.
| | - Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Sang Lim Choi
- Department of Radiology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Sung Won Kim
- Department of Radiology, Research Institute of Radiological Science, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
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Preventive Transhepatic Tract Embolisation after Percutaneous Biliary Interventions: A Systematic Review. Can J Gastroenterol Hepatol 2020; 2020:8849284. [PMID: 33083384 PMCID: PMC7556068 DOI: 10.1155/2020/8849284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 11/25/2022] Open
Abstract
Preventive transhepatic tract embolisation (PTTE) after percutaneous biliary intervention (PBI) may reduce adverse events. The aim of this systematic review was to analyse feasibility, safety, and efficacy of PTTE with different embolic agents. A systematic literature research was performed according to the PRISMA guidelines. The identified studies were analysed concerning study quality, number of cases, indication, embolic agent, embolisation technique, success, and embolisation-related adverse events. Out of 62 identified records, 7 studies of mainly moderate study quality published through 2019 were included for further analysis. Cyanoacrylate (n = 4), gelatin sponge (n = 2), and coils (n = 1) were used as embolic agents in a total number of 314 patients. Technical success was 96-100%. Embolisation-related adverse events (glue migration, pain) occurred in 10/314 (3.2%) patients. Reduction of PBI-related pain was approved by one controlled study; haemorrhage events were reduced but not clearly significant. Overall, biliary leak, transhepatic bleeding, and PBI-related pain occurred in 7/201 (3.5%), 1/293 (0.3%), and 17/46 (36.9%) documented patients after PTTE. Adverse events which likely could not have been prevented by PTTE occurred in 23/180 (12.8%) patients. Embolic agents were not compared. In conclusion, PTTE is feasible and safe. It is effective concerning the prevention of PBI-related pain, and it may be effective concerning haemorrhage. Prevention of biliary leak is not proven. It remains unclear which embolic agent should be preferred. A prospective randomised trial including all preventable adverse events is lacking.
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Zanvettor A, Lederer W, Glodny B, Chemelli AP, Wiedermann FJ. Procedural sedation and analgesia for percutaneous trans-hepatic biliary drainage: Randomized clinical trial for comparison of two different concepts. Open Med (Wars) 2020; 15:815-821. [PMID: 33336039 PMCID: PMC7712221 DOI: 10.1515/med-2020-0220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/25/2020] [Accepted: 07/17/2020] [Indexed: 12/17/2022] Open
Abstract
Procedural sedation and analgesia (PSA) is important during painful dilatation and stenting in patients undergoing percutaneous trans-hepatic biliary drainage (PTBD). A prospective, nonblinded randomized clinical trial was performed comparing different analgesic regimens with regard to the patient’s comfort. Patients were randomly assigned to two treatment groups in a parallel study, receiving either remifentanil or combined midazolam, piritramide, and S-ketamine. The primary study endpoint was pain intensity before, during, and after the intervention using the numerical rating scale (0, no pain; 10, maximum pain). The secondary study endpoint was the satisfaction of the interventional radiologist. Fifty patients underwent PTBD of whom 19 (38.0%) underwent additional stenting. During intervention, the two groups did not differ significantly. After the intervention, the need for auxiliary opioids was higher (12.5% vs 7.7%; p = 0.571) and nausea/vomiting was more frequently observed (33.4% vs 3.8%; p = 0.007) in patients with remifentanil than in patients with PSA. Overall, 45 patients (90.0%) needed additional administration of non-opioid analgesics during postinterventional observation. Remifentanil and combined midazolam, piritramide, and S-ketamine obtained adequate analgesic effects during PTBD. After the intervention, medications with antiemetics and long-acting analgesics were more frequently administered in patients treated with remifentanil (EudraCT No. 2006-003285-34; institutional funding).
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Affiliation(s)
- Alex Zanvettor
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Wolfgang Lederer
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Bernhard Glodny
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas P Chemelli
- Department of Radiology, Landesklinikum Baden-Moedling, Baden Moedling, Austria
| | - Franz J Wiedermann
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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Augustin AM, Cao V, Fluck F, Kunz J, Bley T, Kickuth R. Percutaneous transhepatic biliary tract embolization using gelatin sponge. Acta Radiol 2019; 60:1194-1199. [PMID: 30628848 DOI: 10.1177/0284185118820049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Anne Marie Augustin
- Julius-Maximilians-University of Würzburg, Institute of Diagnostic and Interventional Radiology, Würzburg, Germany
| | - Victoria Cao
- Julius-Maximilians-University of Würzburg, Institute of Diagnostic and Interventional Radiology, Würzburg, Germany
| | - Friederika Fluck
- Julius-Maximilians-University of Würzburg, Institute of Diagnostic and Interventional Radiology, Würzburg, Germany
| | - Julian Kunz
- Julius-Maximilians-University of Würzburg, Institute of Diagnostic and Interventional Radiology, Würzburg, Germany
| | - Thorsten Bley
- Julius-Maximilians-University of Würzburg, Institute of Diagnostic and Interventional Radiology, Würzburg, Germany
| | - Ralph Kickuth
- Julius-Maximilians-University of Würzburg, Institute of Diagnostic and Interventional Radiology, Würzburg, Germany
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Alvarez-Sánchez MV, Luna OB, Oria I, Marchut K, Fumex F, Singier G, Salgado A, Napoléon B. Feasibility and Safety of Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) for Malignant Biliary Obstruction Associated with Ascites: Results of a Pilot Study. J Gastrointest Surg 2018; 22:1213-1220. [PMID: 29532359 DOI: 10.1007/s11605-018-3731-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/26/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND It has been suggested that EUS-BD may be a feasible and safer alternative to percutaneous transhepatic biliary drainage (PTBD) after failed ERCP in patients with ascites. To date, no study has specifically evaluated the performance of EUS-BD in this context. METHODS Retrospective analysis was done for patients with and without ascites who underwent EUS-BD for malignant biliary obstruction after failed ERCP between July 2010 and September 2014. Complications and technical and clinical successes between the two groups were compared. RESULTS A total of 31 patients were included: 20 patients without ascites (group 1) and 11 with ascites (group 2). Nineteen patients underwent EUS-hepaticogastrostomy (six in group 2), and 12 underwent EUS-choledochoduodenostomy (five in group 2). Technical success was achieved in all patients. Clinical success was observed in 95% (n = 19) in group 1 and 64% (n = 7) in group 2 (p = 0.042). In three out of four patients without clinical success in group 2, the follow-up period was not long enough to observe the clinical response because of early death within the 2 weeks after EUS-BD secondary to disease progression or preprocedural unresponsive sepsis. No significant differences were observed between groups 1 and 2 either in the overall rates of procedural-related complications (20 and 9%, respectively, p = 0.63) or in the rates of major complications (15 vs 9%, respectively, p = 0.639). Stent migration occurred in one patient in each group, intra- or post-procedural bleeding occurred in two patients in group 1, which was conservatively managed, and one patient in group 1 presented biliary leakage. Stent patency and the number of re-interventions were not significantly different. CONCLUSIONS EUS-BD is technically feasible in patients with ascites. Our results suggest that EUS-BD may be a clinically effective and safe alternative after failed ERCP in patients with ascites.
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Affiliation(s)
- María Victoria Alvarez-Sánchez
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France.
- Department of Gastroenterology, Complejo Hospitalario de Pontevedra, Pontevedra, Spain.
- Instituto de Investigación Sanitaria Galicia Sur (IISGS), Pontevedra, Spain.
| | - O B Luna
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Clinica Echoendo, Rio de Janeiro, Brazil
| | - I Oria
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Department of Gastroenterology, Hospital Italiano, Buenos Aires, Argentina
| | - K Marchut
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Department of Gastroenterology, Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | - F Fumex
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - G Singier
- Department of Surgery, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - A Salgado
- Instituto de Investigación Sanitaria Galicia Sur (IISGS), Pontevedra, Spain
| | - B Napoléon
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
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Asadi H, Hollingsworth R, Pennycooke K, Thanaratnam P, Given M, Keeling A, Lee M. A review of percutaneous transhepatic biliary drainage at a tertiary referral centre. Clin Radiol 2016; 71:1312.e7-1312.e11. [DOI: 10.1016/j.crad.2016.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/09/2016] [Accepted: 05/20/2016] [Indexed: 11/16/2022]
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Dale AP, Khan R, Mathew A, Hersey NO, Peck R, Lee F, Goode SD. Hepatic Tract Plug-Embolisation After Biliary Stenting. Is It Worthwhile? Cardiovasc Intervent Radiol 2015; 38:1244-51. [PMID: 25762487 DOI: 10.1007/s00270-015-1058-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 01/19/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE PTC and stenting procedures are associated with significant risks including life-threatening haemorrhage, sepsis, renal failure and high mortality rates. PTC tract closure methods are utilised to reduce haemorrhagic complications despite little evidence to support their use. The current study assesses the incidence of haemorrhagic complications following PTC and stenting procedures, both prior to and following the introduction of a dedicated expanding gelatin foam-targeted embolisation liver tract closure technique. MATERIALS AND METHODS Haemorrhagic complications were retrospectively identified in patients undergoing PTC procedures both prior to (subgroup 1) and following (subgroup 2) the introduction of a dedicated targeted liver tract closure method between 9/11/2010 and 10/08/2012 in a single tertiary referral centre. Mean blood Hb decrease following PTC was established in subgroups 1 and 2. Kaplan-Meier life-table analysis was performed to compare survival outcomes between subgroups using the log-rank test. RESULTS Haemorrhagic complications were significantly reduced following the introduction of the targeted PTC tract closure method [(12 vs. 3 % of subgroups 1 (n = 101) and 2 (n = 92), respectively (p = 0.027)]. Mean blood Hb decrease following PTC was 1.40 versus 0.68 g/dL in subgroups 1 and 2, respectively (p = 0.069). 30-day mortality was 14 and 12 % in subgroups 1 and 2, respectively. 50 % of the entire cohort had died by 174 days post-PTC. CONCLUSION Introduction of liver tract embolisation significantly reduced haemorrhagic complications in our patient cohort. Utilisation of this method has the potential to reduce the morbidity and mortality burden associated with post-PTC haemorrhage by preventing bleeding from the liver access tract.
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Affiliation(s)
- Adam P Dale
- Department of Medical Microbiology, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, Hampshire, RG24 9NA, UK.
| | - Rafeh Khan
- Department of Radiology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
| | - Anup Mathew
- Department of Radiology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
| | - Naomi O Hersey
- Department of Radiology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
| | - Robert Peck
- Department of Radiology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
| | - Frederick Lee
- Department of Radiology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
| | - Stephen D Goode
- Sheffield Vascular Institute, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
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Park SY, Kim J, Kim BW, Wang HJ, Kim SS, Cheong JY, Cho SW, Won JH. Embolization of percutaneous transhepatic portal venous access tract with N-butyl cyanoacrylate. Br J Radiol 2014; 87:20140347. [PMID: 25027034 PMCID: PMC4453156 DOI: 10.1259/bjr.20140347] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 07/07/2014] [Accepted: 07/14/2014] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To evaluate the safety and feasibility of N-butyl cyanoacrylate (N-BCA) embolization of percutaneous transhepatic portal venous access tract and to establish an appropriate technique. METHODS 40 consecutive patients underwent percutaneous transhepatic portal venous intervention for various reasons. Embolization of percutaneous transhepatic portal venous access tract was performed after the procedure in all of the patients using N-BCA and Lipiodol® (Lipiodol Ultra Fluide; Laboratoire Guerbet, Aulnay-sous-Bois, France) mixture. Immediate ultrasonography and fluoroscopy were performed to evaluate perihepatic haematoma formation and unintended embolization of more than one segmental portal vein. Follow-up CT was performed, and haemoglobin and haematocrit levels were checked to evaluate the presence of bleeding. RESULTS Immediate haemostasis was achieved in all of the patients, without development of perihepatic haematoma or unintended embolization of more than one segmental portal vein. Complete embolization of percutaneous access tract was confirmed in 39 out of 40 patients by CT. Seven patients showed decreased haemoglobin and haematocrit levels. Other complications included mild pain at the site of embolization and mild fever, which resolved after conservative management. 16 patients died during the follow-up period owing to progression of the underlying disease. CONCLUSION Embolization of percutaneous transhepatic portal vein access tract with N-BCA is feasible and technically safe. With the appropriate technique, N-BCA can be safely used as an alternate embolic material since it is easy to use and inexpensive compared with other embolic materials. ADVANCES IN KNOWLEDGE This is the first study to investigate the efficacy of N-BCA for percutaneous transhepatic portal venous access tract embolization.
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Affiliation(s)
- S Y Park
- 1 Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
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Seif HMA, Zidan M, Helmy A. One-stage percutaneous triple procedure for treatment of endoscopically unmanageable patients with malignant biliary obstruction and marked ascites. Arab J Gastroenterol 2013; 14:148-53. [PMID: 24433643 DOI: 10.1016/j.ajg.2013.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 08/30/2013] [Accepted: 10/07/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND STUDY AIMS To assess the feasibility, safety and efficacy of one-stage percutaneous triple procedure including; ascites drainage, primary metallic biliary stenting, and tract embolisation with N-butyl 2-cyanoacrylate (NBCA), in treatment of patients with malignant biliary obstruction and marked ascites. PATIENTS AND METHODS This study involved 25 patients with malignant biliary obstruction and marked ascites (age range, 46-78y; mean age±SD, 65y±5) for whom endoscopic treatment failed or was unsuitable. Ascites drainage, percutaneous primary metallic biliary stenting, and tract embolisation with lipiodol/NBCA mixture were performed in a one-stage procedure. The mean±SD follow up period was 26±2weeks. RESULTS The technical and clinical success rates were 96% and 88% respectively. No procedure related deaths or major complications were observed. The reported minor complications included; moderate pain and vomiting during and after balloon dilation, postprocedural cholangitis, and bile leakage in 44%, 16%, and 8% of the patients respectively. Primary stent patency was achieved in 96%. The 30-days mortality was 8%. The stent obstruction occurred in 3 (13%) of the 23 patients who survived more than 30-days. CONCLUSIONS Percutaneous drainage of ascites followed immediately by primary biliary stenting, together with tract embolisation with NBCA is technically feasible, safe, and effective alternative palliative treatment for endoscopically unmanageable patients with malignant biliary obstruction and marked ascites.
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Affiliation(s)
- Hany M A Seif
- Department of Radiology, Assiut University Hospital & Faculty of Medicine, Assiut 71517, Egypt.
| | - Mohammed Zidan
- Department of Radiology, Assiut University Hospital & Faculty of Medicine, Assiut 71517, Egypt
| | - Ahmed Helmy
- Department of Tropical Medicine & Gastroenterology, Assiut University Hospital & Faculty of Medicine, Assiut 71517, Egypt
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van der Merwe SW, Omoshoro-Jones J, Sanyika C. Endocoil placement after endoscopic ultrasound-guided biliary drainage may prevent a bile leak. World J Gastrointest Endosc 2013; 5:246-50. [PMID: 23678378 PMCID: PMC3653024 DOI: 10.4253/wjge.v5.i5.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 02/12/2013] [Accepted: 02/28/2013] [Indexed: 02/05/2023] Open
Abstract
AIM: To further reduce the risk of bleeding or bile leakage.
METHODS: We performed endoscopic ultrasound guided biliary drainage in 6 patients in whom endoscopic retrograde cholangiopancreatography (ERCP) had failed. Biliary access of a dilated segment 2 or 3 duct was achieved from the stomach using a 19G needle. After radiologically confirming access a guide wire was placed, a transhepatic tract created using a 6 Fr cystotome followed by balloon dilation of the stricture and antegrade metallic stent placement across the malignant obstruction. This was followed by placement of an endocoil in the transhepatic tract.
RESULTS: Dilated segmental ducts were observed in all patients with the linear endoscopic ultrasound scope from the proximal stomach. Transgastric biliary access was obtained using a 19G needle in all patients. Biliary drainage was achieved in all patients. Placement of an endocoil was possible in 5/6 patients. All patients responded to biliary drainage and no complications occurred.
CONCLUSION: We show that placing endocoils at the time of endoscopic ultrasound guided biliary stenting is feasible and may reduce the risk of bleeding or bile leakage.
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Affiliation(s)
- Schalk Willem van der Merwe
- Schalk Willem van der Merwe, Hepatology and GI Research Laboratory, Department of Immunology, University of Pretoria, Pretoria 0002, South Africa
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Sofue K, Arai Y, Takeuchi Y, Fujiwara H, Tokue H, Sugimura K. Safety and efficacy of primary metallic biliary stent placement with tract embolization in patients with massive ascites: a retrospective analysis of 16 patients. J Vasc Interv Radiol 2012; 23:521-7. [PMID: 22464717 DOI: 10.1016/j.jvir.2012.01.073] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 01/15/2012] [Accepted: 01/20/2012] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate the safety and efficacy of primary metallic biliary stent placement with tract embolization in patients with massive ascites. MATERIALS AND METHODS Sixteen patients with malignant biliary obstruction and massive ascites (age range, 44-79 y; median age, 59 y) were treated with primary percutaneous stent placement with tract embolization. These patients were unsuitable candidates for endoscopic intervention. Etiologies of biliary obstruction were gastric cancer with hilar nodal metastases (n = 9), pancreatic carcinoma (n = 5), cholangiocarcinoma (n = 1), and gallbladder carcinoma (n = 1). Eight patients had nonhilar lesions and the remaining eight had hilar lesions. Percutaneous accesses to the biliary system and stent placements were performed in a one-step procedure, and catheters were removed with tract embolization with metallic coils. RESULTS Stent placement and tract embolization were successful in all patients, without external drainage catheters left in place. Significant reduction of serum bilirubin level was observed in 14 patients (87.5%). No bile peritonitis or intraperitoneal hemorrhage occurred. Major complications included postprocedural cholangitis (12.5%), bloody bowel discharge (6.2%), and right pleural effusion (25.0%). One patient who died 19 days after intervention was deemed to represent a procedure-related mortality. During the survival period (range, 19-175 d; median, 66 d), stent occlusion was noted in two patients at 6 and 159 days after the procedure. Primary stent patency was achieved in 14 patients (87.5%). CONCLUSIONS Primary biliary stent placement with tract embolization is technically safe and offers an effective palliative treatment option for patients with malignant biliary obstruction and massive ascites when endoscopic intervention is not possible.
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Affiliation(s)
- Keitaro Sofue
- Division of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
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Lee SA, Lee YS, Lee KS, Jeon GS. Congenital intrahepatic portosystemic venous shunt and liver mass in a child patient: successful endovascular treatment with an amplatzer vascular plug (AVP). Korean J Radiol 2010; 11:583-6. [PMID: 20808706 PMCID: PMC2930171 DOI: 10.3348/kjr.2010.11.5.583] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 04/13/2010] [Indexed: 11/15/2022] Open
Abstract
A congenital intrahepatic portosystemic shunt is a rare anomaly; but, the number of diagnosed cases has increased with advanced imaging tools. Symptomatic portosystemic shunts, especially those that include hyperammonemia, should be treated; and various endovascular treatment methods other than surgery have been reported. Hepatic masses with either an intra- or extrahepatic shunt also have been reported, and the mass is another reason for treatment. Authors report a case of a congenital intrahepatic portosystemic shunt with a hepatic mass that was successfully treated using a percutaneous endovascular approach with vascular plugs. By the time the first short-term follow-up was conducted, the hepatic mass had disappeared.
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Affiliation(s)
- Sae Ah Lee
- Department of Radiology, Dankook University College of Medicine, Dankook University Hospital, Chungcheongnam-do, Korea
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Amonkar SJ, Laasch HU, Valle JW. Pneumoperitoneum following percutaneous biliary intervention: not necessarily a cause for alarm. Cardiovasc Intervent Radiol 2007; 31:439-43. [PMID: 18066618 DOI: 10.1007/s00270-007-9252-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 12/13/2006] [Accepted: 01/12/2007] [Indexed: 11/30/2022]
Abstract
Percutaneous transhepatic cholangiography (PTC) is a well-established technique for assessing and treating obstructive jaundice. Plastic and self-expanding metal stents can be deployed as an alternative when ERCP is not feasible or hilar strictures require an antegrade approach. Complication rates of percutaneous procedures are low, and are usually related to bile leakage or hemorrhage; pneumoperitoneum following PTC is rare and is usually taken to indicate bowel perforation. We describe two cases of pneumoperitoneum without peritonitis following PTC and stenting, both of which resolved spontaneously with conservative management. The literature is reviewed and possible causes discussed.
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Affiliation(s)
- Suraj J Amonkar
- Manchester Radiology Training Scheme, University of Manchester, Manchester, M13 9PL, UK.
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