Biliary and Gastrointestinal Intervention

Abstract

Percutaneous intervention for biliary obstruction, sepsis and stone disease has been in existence since the advent of fine-bore needle access in the 1970s, and percutaneous cholecystostomy since the 1980s. These treatments have revolutionised biliary intervention, which formerly involved complex and often risky surgery. Decompression of biliary obstruction via percutaneous drainage may be life-saving in the setting of biliary sepsis, offering a bridge to definitive treatment of choledocholithiasis. Percutaneous stent placement for benign or malignant strictures offers relief of obstructive jaundice and its associated morbidity. Gastrointestinal tract intervention has traditionally been endoscopic or surgical, but there is a role for fluoroscopically-guided intervention in certain scenarios. Percutaneous gastrostomy placement (also known as Radiologically Inserted Gastrostomy or RIG) is an alternative to Percutaneous Endoscopic Gastrostomy (PEG). Gastrostomy tubes are indicated for long-term supplementation or replacement of oral feeding when oral intake is insufficient or contraindicated, for example due to neurological swallow impairment. The fluoroscopically-guided approach is particularly useful for patients with subtotal pharyngeal or oesophageal obstruction where passage of an endoscope is unfeasible or fails. Gastrointestinal tract stenting (Oesophageal tumors, obstructing colon tumours or gastric outlet obstruction) can be performed by endoscopists or Interventional Radiologists