Percutaneous-endoscopic biliary stent placement for Billroth II and total gastrectomy with Roux-en-Y enteroenterostomy

Abstract

Some authors believe the endoscopic placement of large biliary prostheses has become the preferred palliative treatment for unresectable malignant obstruction of the biliary ducts.4 The success rate for inserting these stents endoscopically has approached 90%.3.5.6 In a collected series the mean survival of stented patients has ranged from 13 months for those with ampullary cancers to 5 months for patients with lesions above the midcommon bile duct. However, the presence of prior Billroth II partial gastrectomy with its attendant difficulty in ampullary access has been cited for causing failures of endoscopic approach to prosthetic placement.• Other methods of combined percutaneous-endoscopic biliary stenting (PEBS) that achieve placement of 10-11.5 F internal biliary stents with relative ease have recently been described.4.8·9 Our recently described techniqueS appears to be particularly suited to patients with prior gastric resection. We present two examples, one patient having had prior Billroth II and another with prior total gastrectomy and Roux-en-Y enteroenterostomy.