Percutaneous Transhepatic Biliary Drainage Route Research Articles

Acute cholangitis after over-the-scope clip placement involving the duodenal papilla that was rescued by antegrade stenting via the percutaneous transhepatic biliary drainage route.

Acute cholangitis after over-the-scope clip placement involving the duodenal papilla that was rescued by antegrade stenting via the percutaneous transhepatic biliary drainage route.

Treatment of afferent loop syndrome using digital cholangioscopy through the percutaneous transhepatic biliary drainage route.

Treatment of afferent loop syndrome using digital cholangioscopy through the percutaneous transhepatic biliary drainage route.

Palliation of Obstructive Jaundice: Endoscopic Ultrasound‑guided Choledochoduodenostomy in the Presence of Bleeding Duodenal Infiltration Due to Metastatic Urinary Bladder Cancer

Obstructive jaundice is a common manifestation of malignancies involving pancreaticobiliary area of the gastrointestinal tract. The palliation of obstructive jaundice involves bypassing the obstruction by an endoprosthesis using either endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage route. Endoscopic ultrasound‑guided choledochoduodenostomy (ECD) is a challenging alternative for obstructive jaundice due to distal bile duct obstruction in patients who have failed ERCP. In this report, we describe a challenging case of disseminated urinary bladder cancer that presented with extensive duodenal as well as periduodenal infiltration leading on to gastrointestinal bleed and severe pruritus along with obstructive jaundice and was successfully managed with initial argon plasma coagulation of bleeding duodenal lesions followed by ECD.

Biliary stone removal through the percutaneous transhepatic biliary drainage route, focusing on the balloon sphincteroplasty flushing technique: a single center study with 916 patients.

To present our experience in biliary stone removal (BSR) through the percutaneous transhepatic biliary drainage (PTBD) route in 916 patients, and discuss its clinical usefulness. From 2001 to 2015, 916 patients (479 male patients and 437 female patients; age range, 22-92years; mean age, 67years) with 52 recurring cases, so a total of 968 cases, were enrolled in this study and retrospectively reviewed. PTBD was performed in all patients. BSR was performed using a combination of a balloon sphincteroplasty flushing technique, a pushing technique after sphincteroplasty, and classical extraction technique, decided case by case. A complete removal was achieved in 893 cases (92.3%) and the overall clinical success rate was 99.3%. Failure occurred in 7 cases (0.7%), and the causes of failure were stone impaction (n=5) and intrahepatic bile duct stricture (n=2). Sphincteroplasty was performed in 902 cases (93.2%). Balloon sphincteroplasty flushing technique was used in 829 (85.6%) cases. There was no major complication. Transient minor complications were seen in 86 cases (8.9%). BSR through the PTBD route using a combination of techniques, including balloon sphincteroplasty flushing, is a safe and effective treatment modality to remove biliary stones.

Intrahepatic Segmental Portal Vein Thrombosis After Living-Related Donor Liver Transplantation

BackgroundIntrahepatic segmental portal vein thrombosis after living-related liver transplantation (LRLT) is uncommon. The cause remains unclear. MethodsAfter providing written informed consent, 25 recipients receiving LRLT at our institution from January 2011 to September 2013 were enrolled in this study. We performed triphase computerized tomographic (CT) study of the liver graft of each recipient 1 month after LRLT. The patencies of hepatic artery, portal vein, and hepatic vein were evaluated in detail. The triphase CT scans of the liver of each donor before transplantation also were reviewed. Thrombosis of the intrahepatic segmental portal vein was defined as the occlusion site of the portal vein being intrahepatic. Extrahepatic portal vein thrombosis was excluded in this study. ResultsAmong the 25 patients, 2 (8%) developed thrombosis of intrahepatic segmental portal vein. One 47-year-old man received LRLT for hepatitis B viral infection–related liver cirrhosis (Child-Pugh class C) with 3 hepatocellular carcinomas (total tumor volume <8 cm). Another 53-year-old man received LRLT for alcoholic liver cirrhosis (Child-Pugh class C). Both had developed progressive jaundice and cholangitis 1 month after surgery. Intrahepatic biliary stricture was found on the follow-up magnetic resonance images. However, liver triphase CT study demonstrated occlusion of intrahepatic portal vein of segment 8 in each patient. Radiologic interventions and balloon dilatation therapy via percutaneous transhepatic biliary drainage route improved the symptoms and signs of cholangitis and obstructive jaundice for both. ConclusionsThrombosis of intrahepatic segmental portal vein is not common but is usually associated with complications of intrahepatic bile duct. Early detection is important, and follow-up CT study of liver is suggested.

9:12 AM; Abstract No. 97 - A single center study of biliary stone removal through the percutaneous transhepatic biliary drainage route: results of 695 patients

9:12 AM; Abstract No. 97 - A single center study of biliary stone removal through the percutaneous transhepatic biliary drainage route: results of 695 patients

A novel technique for treatment of intrahepatic biliary obstruction using an endobronchial ultrasound system.

Biliary obstruction (BO) is one of the complications after hepatobiliary surgery decreasing patients' quality of life. Existing interventional methods, such as endoscopic retrograde biliary drainage, occasionally fail to treat this condition. This is the first report of treatment of BO using an endobronchial ultrasound (EBUS) system. A 65-year-old woman developed BO at the confluence of the bile duct of segment 3 of the liver (B3) and segment 2 (B2) after extended right hepatectomy for hepatocellular carcinoma. Percutaneous transhepatic biliary drainage (PTBD) was performed through B3, and its fistula was dilated up to the size of an 18-Fr PTBD silicone catheter. An EBUS endoscope was inserted through the dilated PTBD route. B2 was punctured through the EBUS endoscope inserted to B3 just before the obstruction with a needle for fine-needle aspiration biopsy. A guidewire was inserted to the common bile duct through the needle, and a 7.2-Fr PTBD catheter was placed over the guidewire. The inserted PTBD catheter was clamped, and internal biliary drainage was established. The catheter was patent for 24months, and the patient had no episodes of jaundice or cholangitis. This technique using the EBUS system can be a treatment option for BO.

Magnetic Compression Anastomosis for Bile Duct Stenosis After Donor Left Hepatectomy: A Case Report

Magnetic compression anastomosis (MCA) provides a minimally invasive treatment creating a nonsurgical, sutureless enteric anastomosis in conjunction with an interventional radiologic technique by using 2 high-power magnets. Recently, the MCA technique has been applied to bile duct strictures after living donor liver transplantation or major hepatectomy. Herein we described use of MCA for bile duct stenosis 5 months after donor left hepatectomy in a 24-year-old man who presented with a stricture at the porta hepatis and intrahepatic bile duct dilatation. Unsuccessful transpapillary biliary drainage and balloon dilatation through a percutaneous transhepatic biliary drainage (PTBD) route led to the MCA. A 4-mm-diameter cylindrical samarium-cobalt (Sm-Co) daughter magnet with a long nylon wire was placed at the superior site of the obstruction through the PTBD route. A 5-mm-diameter Sm-Co parent magnet with an attached nylon handle was endoscopically inserted into the common bile duct and placed at the inferior site of obstruction. The 2 magnets were attracted, sandwiching the stricture and establishing a reanastomosis. In conclusion, the MCA technique was a unique procedure for choledochocholedochostomy in a patient with bile duct stenosis after donor hepatectomy.

Magnetic compression anastomosis for biliary obstruction: review and experience at Tokyo Medical University Hospital

Magnetic compression anastomosis (MCA) is a revolutionary, minimally invasive method of performing choledochoenterostomy or choledochocholedochostomy without using surgical techniques in patients with biliary stricture or obstruction. Herein, we describe a case series of MCA for severe biliary stricture or obstruction, which could not be treated with conventional therapies. Two patients with biliary obstruction were treated using MCA for choledochocholedochostomy and choledochoenterostomy at Tokyo Medical University Hospital and Tokyo Medical University Hachioji Medical Center. Endoscopically, a samarium-cobalt (Sm-Co) rare-earth magnet was placed at the superior site of obstruction through the percutaneous transhepatic biliary drainage route and another Sm-Co magnet was placed at the inferior site of obstruction. A comprehensive computer-aided literature search for MCA was performed up to September 2009 by using MEDLINE and EMBASE. MCA techniques enabled complete anastomosis in both cases without procedure-related complications. The MCA technique is a revolutionary method of performing choledochocholedochostomy and choledochoenterostomy interventionally in patients with biliary obstruction, for whom the conventional endoscopic procedure is not available, or in candidates who are deemed unsuitable for surgery.

Magnetic Compression Duct-to-duct Anastomosis for Biliary Obstruction in a Patient with Living Donor Liver Transplantation

Magnetic compression anastomosis (MCA) is a minimally invasive method of performing choledochocholedochostomy without surgery in patients with biliary stricture or obstruction. We describe a successful case involving magnetic compression duct-to-duct biliary reconstruction in right-lobe living donor liver transplantation (RL-LDLT). Endoscopically, a samarium-cobalt (Sm-Co) rare-earth magnet was placed at the superior site of obstruction via the percutaneous transhepatic biliary drainage route, and another Sm-Co magnet was also placed at the inferior site of obstruction with the aid of an endoscope. MCA techniques enabled complete anastomosis without procedure-related complications. In conclusion, the MCA technique is a revolutionary method of performing choledochocholedochostomy in patients with biliary obstruction after LDLT.

Diagnosis and treatment of biliary tract diseases using a percutaneous transhepatic biliary drainage route

Diagnosis and treatment of biliary tract diseases using a percutaneous transhepatic biliary drainage route

Percutaneous Treatment of Extrahepatic Bile Duct Stones Assisted by Balloon Sphincteroplasty and Occlusion Balloon

ObjectiveTo describe the technical feasibility and usefulness of extrahepatic biliary stone removal by balloon sphincteroplasty and occlusion balloon pushing.Materials and MethodsFifteen patients with extrahepatic bile duct stones were included in this study. Endoscopic stone removal was not successful in 13 patients, and two patients refused the procedure due to endoscopy phobia. At first, all patients underwent percutaneous transhepatic biliary drainage (PTBD). A few days later, through the PTBD route, balloon assisted dilatation for common bile duct (CBD) sphincter was performed, and then the stones were pushed into the duodenum using an 11.5 mm occlusion balloon. Success rate, reason for failure, and complications associated with the procedure were evaluated.ResultsEight patients had one stone, five patients had two stones, and two patients had more than five stones. The procedure was successful in 13 patients (13/15). In 12 of the patients, all stones were removed in the first trial. In one patient, residual stones were discovered on follow-up cholangiography, and were subsequently removed in the second trial. Technical failure occurred in two patients. Both of these patients had severely dilated CBD and multiple stones with various sizes. Ten patients complained of pain in the right upper quadrant and epigastrium of the abdomen immediately following the procedure, but there were no significant procedure-related complications such as bleeding or pancreatitis.ConclusionPercutaneous extrahepatic biliary stone removal by balloon sphincteroplasty and subsequent stone pushing with occlusion balloon is an effective, safe, and technically feasible procedure which can be used as an alternative method in patients when endoscopic extrahepatic biliary stone removal was not successful.

Photodynamic Therapy for Malignant Biliary Obstruction: A Case Series

We describe four elderly patients (age range 73-85 years) with bile duct carcinoma who were treated with photodynamic therapy. These patients could not be treated surgically because of the presence of cardiopulmonary disease and the extent of the bile duct carcinoma. Prior to photodynamic treatment the patients underwent percutaneous transhepatic biliary drainage (PTBD) to relieve jaundice. The photodynamic therapy was carried out under percutaneous transhepatic cholangioscopy, 2 days after intravenous administration of sodium porfimer (2 mg/kg). Excimer dye laser was used to irradiate the obstructive lesion with an energy dosage of 50 J/cm2 (total irradiation dose 150-250 J/cm2) and stenotic site with a dosage of 50-100 J/cm2. Photodynamic therapy was achieved safely without occurrence of cholangitis in all patients, and was followed by metallic stent placement, resulting in the improvement of performance levels in three patients who did not have liver metastases. Photodynamic therapy via the PTBD route is a safe and promising palliative therapy for selected elderly patients with bile duct carcinoma.

Percutaneous transhepatic cholangioscopy in the treatment of complicated intrahepatic biliary strictures and hepatolithiasis with internal metallic stent.

For recurrent hepatolithiasis coexisting with a complicated long-segment intrahepatic biliary stricture, repeated surgeries, balloon dilation of the stricture, and external-internal stenting may still fail to solve the problem. We tried using a Gianturco-Rosch metallic Z internal stent (Wilson-Cook Medical, Inc., Bloomington, IN, USA) with the aid of percutaneous transhepatic cholangioscopy (PTCS) to treat such patients. Eight patients had a Z stent placed through a percutaneous transhepatic biliary drainage tract. Immediately after stent placement, PTCS was inserted via the percutaneous transhepatic biliary drainage route and a part of the wire skirt not firmly anchored in one of the eight patients was detected. It was successfully repositioned using PTCS. Recurrent cholangitis developed in three patients 6, 7, and 30 months, respectively, after stent placement. PTCS was undertaken again through a reestablished percutaneous transhepatic biliary drainage route and revealed sludge in their stent lumens. We cleared it by PTCS. No further cases of cholangitis occurred in later follow-up. PTCS is useful in ensuring adequate stent position, diagnosing and treating the causes of recurrent cholangitis, and prolonging the function of stents.

Combined Use of Uncovered Duodenal and Covered Biliary Metallic Stent for Carcinoma of the Papilla of Vater

We have reported successful implantation of self‐expandable metallic stents for palliative treatment in a case of an 87‐year‐old female patient with carcinoma of the papilla of Vater. She suffered from both duodenal and biliary stenoses, but refused surgical treatment. For the duodenal stenting, a self‐expandable knitted nitinol metallic stent, for esophageal use, was inserted endoscopically. For the biliary stenting, a self‐expandable metallic stent, partially polyurethane‐covered on the proximal part to prevent tumor ingrowth and overgrowth, was inserted via the percutaneous transhepatic biliary drainage route. No major complications occured during these procedures. After the two stents were inserted in an end‐to‐side fashion, she was able to eat a normal diet adequately and suffered from no abdominal symptoms and jaundice during the follow‐up period of 13 months. These stenting procedures might be less invasive and more useful than surgical treatment and provide long patency of biliary stenting and a good quality of life.

POSTOPERATIVE BENIGN BILIARY STRICTURE SUCCESSFULLY TREATED WITH A STRECKER EXPANDABLE METALIC STENT : CASE REPORT

Postoperative benign biliary stricture was successfully treated with a new type of biliary stent (Strecker expandable stent). A 70-year-old woman was transferred to our hospital because of cholangitis symptoms. She had a history of cholecystectomy for cholecystolithiasis at 45 years of age and endoscopic sphincterectomy for choledocholithiasis at 63 years of age. Endoscopic retrograde cholangiograms revealed a stricture of the common hepatic duct about 3 cm in length. Percutaneous transhepatic biliary drainage (PTBD) was performed and biopsy specimens obtained under percutaneous transhepatic cholangioscopy (PTCS) showed benign histology. We introduced a Strecker expandable metallic stent into the biliary stricture via the PTBD route under X-ray fluoroscopy. Neither migration nor occlusion of the stent were observed 38 months after its insertion. This stent is useful for the treatment of postoperative benign biliary stricture.