Abstract
Endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy is a well-established procedure for the treatment of bile duct strictures. However, the procedure is difficult to perform in patients with intradiverticular papillae or tumor infiltration of the major papilla. Percutaneous transhepatic biliary stenting (PTBS) is commonly used in the management of malignant biliary stricture. The current study reports two cases of PTBS performed to treat malignant obstructive jaundice caused by ampullary carcinoma complicated with intradiverticular papillae. PTBS is potentially a safe technique for this relatively rare condition.
Highlights
Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay treatment for numerous patients with malignant obstructive jaundice
Failed therapeutic ERCP due to deep cannulation of the obstructed bile duct is precluded by severe duct angulation, a tight stricture or infiltration by the tumor, and have been previously reported [3,4]
ERCP with modified techniques to treat obstructive jaundice in patients with intradiverticular papilla has been described in the literature [2,4,5,6,7,8]
Summary
Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay treatment for numerous patients with malignant obstructive jaundice. Percutaneous transhepatic biliary drainage (PTBD) with stent insertion is an established procedure for the palliation of patients with malignant biliary strictures. The current case report describes percutaneous transhepatic biliary stenting (PTBS) performed in two patients with malignant biliary. The major papilla was located inside a large juxtapapillary diverticulum during the procedure CT performed 4 days after PTBS showed the tumor surrounding the intradiverticular papilla (Fig. 4). NIU et al: PTBS IN PATIENTS WITH INTRADIVERTICULAR PAPILLAE AND MALIGNANT BILIARY STRICTURE. A 0.8x4.0‐cm balloon (William Cook Eurpoe ApS) was advanced over the guidewire towards the duodenum to dilate the stricture and papilla orifice. A self‐expanding metallic stent (Zilver; William Cook Eurpoe ApS) was inserted alongside the guidewire and through the papilla into the duodenum. The patients remained well at the six‐month post‐procedure follow‐up visit
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