Transhepatic Cholangiography Research Articles

Diagnostic and therapeutic values of percutaneous trans-hepatic cholangiography (PTC) and biliary drainage in obstructive jaundice patients

Background: Percutaneous trans-hepatic cholangiography is an interventional diagnostic and therapeutic procedure used in the diagnosis and management of obstructive jaundice. The aim of the study was to evaluate the diagnostic and therapeutic values of percutaneous trans-hepatic cholangiography and biliary drainage in obstructive jaundice patients. Patients and Methods: Study included 30 patients with obstructive jaundice. All patients performed percutaneous trans-hepatic cholangiography. Diagnostic percutaneous trans-hepatic cholangiography was done first to detect the site, level and shape of the stenosis then therapeutic Percutaneous biliary drainage was done to drain the bile from the dilated biliary tree. Results: This study included 30 patients with obstructive jaundice (21 male and 9 females). 96.66% of patients had malignant obstruction and 3.33% had benign obstruction. The accuracy of PTC in diagnosis of biliary dilatation, cause and level of obstruction was 100%. External biliary drainage done for all 30 patients then internal stent was inserted for 26 patients with technical success rate for passing the stricture was 86.66 %. Technical success rate of percutaneous biliary drainage was 100% manifested by decrease in the serum bilirubin level and improvement of liver function tests in all patients 1 week after the drainage. Technique-related morbidity was 13.33 % with no procedure-related mortality Conclusion: Percutaneous trans-hepatic cholangiography has high diagnostic accuracy rate 100% in diagnosis of biliary dilatation, cause and level of biliary obstruction. Percutaneous trans-hepatic biliary drainage has high therapeutic success rate of bile drainage 100% with high technical success rate 86.66% for passing the stricture in patients with obstructive jaundice.

Subclinical biliary strictures as a cause of long-term allograft dysfunction in children who underwent liver transplantation.

We aimed to evaluate the role of liver biopsy to predict subclinical biliary strictures (BS) and assess the impact of BS on long-term allograft dysfunction following liver transplantation in children (LT). We reviewed all liver biopsies performed from 2012-2018. Percutaneous transhepatic cholangiography (PTC) was performed in patients presenting cholangiolar proliferation on cytokeratin-7 stained sections. We performed 271 biopsies in 161 children (86% with a left lateral segment); 44/161 (27%) presented with diffuse or multifocal cholangiolar proliferation. Among them, a tight BS was confirmed in 38/44 (86%, 24% of total) and it was managed by balloon dilatation. Cholangiolar proliferation showed a positive predictive value (PPV) for BS of 86.4%. Levels of alkaline phosphatase >325IU/L predicted BS (P=.007). Dilatation of intrahepatic bile ducts on ultrasound was found only in 44% of patients with BS. Following a median follow-up of 9.2years, only 15/38 (39%) patients resolved the BS. In conclusion subclinical BS is very common and probably underdiagnosed in these patients. Histological evidence of cholangiolar proliferation detectable by cytokeratin-7 immunostain should be preferred to liver function tests and ultrasound to suspect BS. BS in this setting should be regarded as a main cause of long-term allograft dysfunction.

Multidisciplinary Approach to Malignant Biliary Obstruction

AbstractTreatment of malignant biliary obstruction (MBO) requires the coordination of multiple specialties, including oncologists, surgeons, gastroenterologists, and interventional radiologists. If the tumor is resectable, surgical candidates can usually proceed to surgery without preoperative biliary drainage. For patients who undergo biliary drainage, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) combined with biliary stenting are techniques with comparable technical success and mortality, each with distinct advantages and risks. Advances in endoscopic ultrasound allow drainage in patients with challenging anatomy. There are a multitude of devices used for biliary decompression. Self-expanding metal stents (SEMS), with longer patency rates, are in most instances preferred over plastic stents for MBO, especially in patients with life expectancy more than 3 to 4 months. Advantages of covered SEMS versus uncovered SEMS remain controversial as covered stents can prevent tumor ingrowth but at the expense of potential increase in stent migrations. Extra-anatomic biliary drainage using lumen-apposing metal stents is an emerging technique which shows promise when conventional ERCP fails. It is imperative to understand these techniques when tailoring a treatment strategy. The goal of this article is to discuss a multidisciplinary approach for MBO to promote comprehensive care using case examples to highlight essential principles.

Clinical Presentation and Different Treatment Modalities of Obstructed Jaundice

Objective: To determine the clinical presentation and different treatment modalities of obstructed jaundice at tertiary care Hospital.
 Study Design: Prospective observational study.
 Place and Duration: Present study was conducted in the Department of general Surgery of Liaquat University of Medical and Health Sciences, Jamshoro during two years from July 2015 to June 2017.
 Patients and Methods: Total 50 patients having obstructed jaundice and either gender were evaluated after taking history, clinical examinations including specific investigations like ultrasound of abdomen, liver function test (LFT), magnetic resonance cholangiopancreatography (MRCP), computed tomography (CT) endoscopic retrograde cholangio pancreatography (ERCP), magnetic resonance imaging (MRI), percutaneous transhepatic cholangiography (PTC) biopsy, tumor markers and x- ray chest for diagnosis and prognosis purpose. All the data was recorded via self-made proforma. 
 Results: Out of all cases, 20 patients were in age group of 30 to 45 year, 21 patients were in age group 46 to 64 years and 09 patients were in age group 65 to 80 year. Thirty one patients were presented with intermittent jaundice and pain,14 patients had jaundice, pruritus, pale stool, dark urine and 5 patients were presented with jaundice, pruritus, pale stool with dark urine, pain, anorexia and weight loss. Thirty one patients were diagnosed with benign lesions and 19 patients had malignant lesions. Most of the patients (26.52%) were treated by ERCP, stent. Fifteen underwent open surgery, and 9 were treated by palliative procedure, chemotherapy, radiotherapy and gene therapy.
 Conclusion: Obstructed jaundice is a critical problem all over the world, in which initially patients present with jaundice, pain, pruritus with pale stool, dark urine and weight loss. Patients can be treated by ERCP, stent. Fifteen patients underwent open surgery and 9 were treated by palliative procedure, chemotherapy, radiotherapy and gene therapy.

Su1327 ENDOSCOPIC ULTRASOUND GUIDED CHOLEDOCHODUODENOSTOMY IS A DURABLE, SAFE AND SUCCESSFUL PROCEDURE IN MALIGNANT BILIARY OBSTRUCTION

Endoscopic retrograde cholangiopancreatography (ERCP) with biliary stenting is the standard therapy for palliation of malignant biliary obstruction (MBO). In cases of failed ERCP, patients can undergo either percutaneous transhepatic cholangiography (PTC) drainage or endoscopic ultrasound-guided drainage, including choledochoduodenostomy (EUS-CD). The aim of this study is to compare PTC drainage to EUS-CD in patients with malignant biliary obstruction and failed ERCP. We performed a retrospective cohort study of patients with MBO and failed ERCP identified at Mayo Clinic Rochester from the 2014-2019. Patients with benign biliary obstruction or altered anatomy were excluded. Primary outcomes were technical and clinical success (bilirubin decrease of at least by 50% at 1 week). Secondary outcomes were adverse events (AEs), need for reintervention and survival. Cox regression analysis was used to compare time to reintervention and survival. A total of 36 patients (26 PTC, 13 CD) with malignant biliary obstruction who failed ERCP were included. There were no significant differences between the groups (Table 1). The causes of MBO were pancreatic adenocarcinoma 22 (61.1%), gastroduodenal adenocarcinoma 6 (16.7%), metastatic disease 5 (13.9%), cholangiocarcinoma 2 (5.5%) and myxoid sarcoma 1 (2.8%). Duodenal stricture preventing access to the major papilla was the main cause for failed ERCP in 17 patients (47.2%). Lumen apposing metal stents were used for CD in 9 patients (69.2%). A 10 Fr catheter was used for initial PTC for all patients in the PTS group. Technical and clinical success was 95.6% and 77.3% in the PTC group and 100% and 92.3% in the CD group, P=0.45 and P=0.25. There was one stent maldeplolyment in the CD group which was managed immediately with re-stenting and no immediate AE in the PTC group. Long term AEs were fewer in the CD group (0%) compared to the PTC group (7; 30.4%, P=0.01). The most common AE in the PTC group was clinically significant catheter occlusion in 5 patients (21.7%). 14 patients (60.9%) with PTC required reintervention compared to 0 (0%) after CD, P<0.001. Half of the reinterventions after PTC (7) were elective tube exchanges. There was no significant difference in survival between the two groups HR: 0.75 (95% CI: 0.3 -1.8, P=0.5). EUS-CD is a technically and clinically highly successful procedure without an increased risk for AEs in malignant biliary obstruction after failed ERCP. EUS-CD reduces reinterventions, which enhances end of life quality in patients with advanced malignancy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Prognostic and predictive factors for Taiwanese patients with advanced biliary tract cancer undergoing frontline chemotherapy with gemcitabine and cisplatin: a real-world experience

BackgroundChemotherapy with gemcitabine and cisplatin has been the standard of care in first-line chemotherapy for advanced biliary tract cancer (BTC) since the trial ABC-02 was published in 2010. We aimed to investigate the prognostic and predictive factors of this regimen in a cohort of Taiwanese patients with advanced BTC.MethodsA total of 118 patients with histologically confirmed BTC treated at Chang Gung Memorial Hospital at Linkou from 2012 to 2017 were retrospectively reviewed.ResultsThe median progression-free survival (PFS) and overall survival (OS) were 3.6 months and 8.4 months, respectively. In the multivariate analysis, neutrophil to lymphocyte ratio (NLR) > 7.45, biliary drainage requiring both percutaneous transhepatic cholangiography drainage (PTCD) and internal stenting, and tumor responses with progressive diseases and not assessed were independent poor prognostic factors for PFS. Male sex, NLR > 7.45, alkaline phosphatase> 94 U/L, biliary drainage requiring both PTCD and internal stenting, and tumor responses with stable disease, progressive diseases and not assessed were independent poor prognostic factors for OS. Monocyte to lymphocyte ratio (MLR) ≤ 0.28 was the only significant predictive factor for the tumor response. Patients with complete response/partial response had significantly lower MLR than patients with other tumor responses.ConclusionWe identified three important prognostic factors, namely tumor response, NLR, and biliary drainage requiring both PTCD and internal stenting for both PFS and OS. MLR was the only significant predictive factor for the tumor response. These findings could provide physicians with more information to justify the clinical outcomes in patients with advanced BTC in real-world practice.

Adherence to Antibiotic Prophylaxis for Percutaneous Transhepatic Cholangiography: A Single-Centre Experience.

BackgroundPercutaneous transhepatic cholangiography (PTC) is associated with high rates of sepsis. The aim of the current study was to audit the adherence to trust guidelines on antibiotic prophylaxis in patients undergoing PTC. Secondary aims included the management and outcome of patients with sepsis post-procedure.MethodsThis was a retrospective analysis of 50 consecutive patients who underwent a PTC procedure between January 2016 to January 2017. Collated data included PTC indication, drug allergies, antibiotics given pre-PTC, culture results, and antibiotic sensitivities within one-month post-PTC.ResultsComplete data were available for 41 patients and 61 PTC procedures. The median age was 68 years, and 51% were females. The indication for PTC was malignancy (n=32, 78%), benign conditions (n=1, 2%), and unknown diagnosis at the time of PTC (n=8, 20%). Three cases did not receive antibiotic prophylaxis. Only 27 (44%) PTC procedures received appropriate pre-PTC antibiotics as per guidelines, with no adherence to guidelines in all penicillin-allergic patients. In six patients who were not being treated for sepsis pre-PTC, a newly positive post-PTC blood/drain culture was observed within one month. Organisms grown in the post-PTC cultures were 56% gram-negative, the majority being Escherichia coli. The 30-day mortality rate was 12.2% (5/41).ConclusionsPoor adherence to recommended antibiotic regimes is a significant contributing factor for sepsis post-PTC. Investigating barriers to guideline implementation, stricter adherence, and peer education are interventions that could improve post-PTC outcomes.

Dyna-CT-Based Three-Dimensional Cholangiography in Biliary Duct Assessment of Hilar Cholangiocarcinoma

Cholangiography is important for evaluating the resectability of hilar cholangiocarcinoma. This study evaluated Dyna-CT combined with direct cholangiography in the assessment of tumor extent and resectability of hilar cholangiocarcinoma. Sixteen patients with pathologically proven hilar cholangiocarcinoma who underwent preoperative biliary drainage and the Dyna-CT with direct cholangiography (percutaneous transhepatic cholangiography [PTC]) were included in this retrospective study. The image quality was compared with MRI cholangiography. An experienced radiologist and surgeon reviewed the image to evaluate the tumor extent for the involvement of extra- and intrahepatic ducts. The reader performance was evaluated by calculating sensitivity, specificity, and overall accuracy. Correlations were made with the resected specimens or surgical findings. All of the patients required biliary drainage, and the PTC procedure was performed successfully. No major complications were encountered. The Dyna-CT image processing can produce a precise three-dimensional overview of the biliary tree. The image quality score of the Dyna-CT was similar to the MRI cholangiography. The Dyna-CT had some advantage for more small branches. In addition, the shape-fitting of intrahepatic bile ducts was excellent. For image analysis, the overall accuracy for predicting the involvement of the bilateral secondary biliary confluences was 96.9%. Surgery showed good consistency with the Dyna-CT cholangiography. The Dyna-CT-based three-dimensional cholangiography is a new imaging method that can provide surgeons with three-dimensional and intuitive images of the biliary tree and provide useful information for evaluating the anatomical structure of the bile duct prior to surgery.

Fluoroscopic Cholangiography: Anatomy, Pathology, and Intervention

Direct intraoperative cholangiography, endoscopic retrograde cholangiopancreatography, T-tube cholangiography, and percutaneous transhepatic cholangiography are routine procedures performed by interventionalists. Radiologists must understand how to interpret direct cholangiography to facilitate multidisciplinary communication, correlate findings with magnetic resonance cholangiopancreatography, and improve patient care.

Peculiarities of percutaneous stenting interventions on the bile ducts

Bile duct stenting is not a common intervention in most multidisciplinary hospitals in our city. The article presents our 5-year experience with 84 antegrade prosthetic interventions using self-expanding nitinol stents and endoprostheses. The interventions were carried out in 2 stages: percutaneous transhepatic cholangiography drainage followed by biliary stenting or endoprosthetics. All patients were operated on for obstructive jaundice: 10 benign genesis, 74 malignant. The analysis of postoperative pancreatitis with primary drainage intervention development allowed us to find the algorithm for its prediction, early detection and treatment. The possibilities of using partially-coated nitinol stents in different variants of the biliary tree anatomy were considered. The article also provides evidence for advisability of endoprosthesses in benign strictures of the bile ducts.

An Overview on Primary Sclerosing Cholangitis.

Primary sclerosing cholangitis is a progressive liver disease characterized by chronic inflammation leading to liver fibrosis and cirrhosis. Even though the exact pathogenesis is still unclear, a combination of autoimmune, environmental, and ischemic factors could explain certain aspects of the disease. The most important diagnostic step is cholangiography, which can be obtained either by endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance cholangiography (MRCP as the gold standard), or percutaneous transhepatic cholangiography. It shows multifocal short biliary duct strictures leading to the “beaded” aspect. Cholangiocarcinoma and colorectal adenocarcinoma are the most feared complications in patients with Primary sclerosing cholangitis (PSC). Continuous screening consists of annual clinical, biochemical, and ultrasound assessments in asymptomatic patients and annual colonoscopy in patients with PSC and inflammatory bowel disease. In newly diagnosed patients with PSC, colonoscopy is mandatory and, if negative, then, a repeat colonoscopy should be performed in 3–5 years. The lack of efficient curative medical treatment makes invasive treatments such as liver transplant and endoscopy the mainstream for managing PSC and its complications. Until now, even though only ursodeoxycholic acid has shown a moderate clinical, biochemical, and even histological improvement, it has no significant influence on the risk of cholangiocarcinoma, liver transplant need, or death risk and it is no longer recommended in treating early PSC. Further studies are in progress to establish the effect of molecular-targeted therapies in PSC.

Postsurgical Management of Dilated Biliary Tract in Children: Ultrasound-Guided Percutaneous Transhepatic Cholangial Drainage and Subsequent Percutaneous Ultrasound Cholangiography.

OBJECTIVE. The purpose of this study was to evaluate the feasibility of ultrasound (US)-guided percutaneous transhepatic cholangial drainage (PTCD) and consequent percutaneous US cholangiography in managing the dilated biliary tracts of children who have undergone hepatobiliary surgery. SUBJECTS AND METHODS. Sixteen children (11 boys, five girls; age range, 3-144 months) who underwent hepatobiliary surgery from December 2016 to October 2018 and had US evidence of biliary dilatation were included. All patients had undergone US-guided PTCD because of elevated postoperative serum bilirubin levels or bile duct infection. Immediately after the PTCD procedure, diluted sulphur hexafluoride microbubbles dispersion was injected through the PTCD tube to evaluate the anastomosis and the intrahepatic bile duct tree. Laboratory results, including those of serum bilirubin measurement, liver function tests, and routine blood tests, were evaluated before and after PTCD. Nine of 16 patients also underwent percutaneous transhepatic cholangiography (PTC). The percutaneous US cholangiography findings were evaluated and compared with the PTC findings. RESULTS. Liver enzyme levels decreased after PTCD with a statistically significant difference from the values before PTCD. Percutaneous US cholangiography showed that the anastomosis in 6 of the 16 patients (37.5%) was patent and depicted the morphologic featuresof intrahepatic bile duct tree in five of these patients. In the other 10 patients, the anastomosis was completely obstructed, and percutaneous US cholangiography depicted the morphologic features of intrahepatic bile duct tree in eight patients. In the nine patients who underwent PTC, the percutaneous US cholangiographic findings were the same as the PTC findings. CONCLUSION. US-guided PTCD is helpful in relieving jaundice and inflammation in children who have undergone hepatobiliary surgery and have biliary dilatation. Findings at consequent percutaneous US cholangiography are comparable to those of PTC in depicting the anastomosis in these patients.

4:03 PM Abstract No. 106 Percutaneous transhepatic cholangiography with biliary intervention for unresectable malignant biliary obstruction following endoscopically placed stents

4:03 PM Abstract No. 106 Percutaneous transhepatic cholangiography with biliary intervention for unresectable malignant biliary obstruction following endoscopically placed stents

Abstract No. 580 Overweight, obesity, and unfavorable outcomes after percutaneous biliary interventions: a national study

to evaluate the role of obesity on short-term outcomes after inpatient percutaneous biliary interventions including percutaneous transhepatic cholangiography, stone removal and biliary drain placement. We hypothesized that there is a dose-dependent relationship between obesity and unfavorable outcomes after percutaneous biliary interventions. Data from the national inpatient sample consisting of up to 97% of US community hospitals were used for this study. Using the ICD9-CM diagnosis codes and BMI values, patients were categorized into 4 groups: underweight, normal weight, overweight, premorbid obesity and morbid obesity. Hospital related outcomes including mortality, length of stay, disposition and hospital charges were compared among the weight groups. An estimated 23,730 ± 537 inpatient percutaneous biliary interventions were performed in the US from 2012–2015, 7.9% (± 0.4) and 2.6% (± 0.2) of which were on patients with obesity and morbid obesity, respectively. In univariate analysis of the outcomes and compared to non-obese patients, patients with obesity had similar post procedure mortality (3.4% ± 0.9 vs. 3.7% ± 0.3), length of stay (average days: 8.3 ± 0.3 vs. 7.5 ± 0.1), routine disposition (49.7% ± 2.7 vs. 48.3% ± 0.8) and total hospital charges (USD: 76,537 ± 4072 vs. 69,871 ± 1332; all P values >0.05). In multivariable modeling and after adjustment for patients’ demographic characteristics and principal diagnosis (including malignancies and sepsis), obesity was associated with similar probability of death (odds ratio [OR]: 0.98 [0.52–1.84], P:0.96) and routine disposition (OR: 0.93 [0.73–1.18], P:0.57), but higher risk of lengthy hospital stay (>8 days; OR: 1.32 [1.05–1.67], P:0.02) and greater hospital charges (>75,000 USD; OR:1.29 [1.02–1.63], P:0.03). A dose-dependent association between weight category and lengthy hospital stay (OR: 1.11 [1.03–1.18], P <0.01) and greater hospital charges (OR: 1.10 [1.03–1.18], P:0.01) was detected. There is a dose-dependent association between obesity, hospital stay and total hospital charges after percutaneous biliary interventions. Every higher weight category is associated with 10 – 11% higher odds of unfavorable outcomes.

Establishing local diagnostic reference levels for pediatric percutaneous transhepatic cholangiography interventions and optimizing the routine practice.

Liver-transplanted, immunosuppressed pediatric patients undergoing repeated percutaneous transhepatic cholangiography (PTC) require optimized exposure to ionizing radiation. To establish local diagnostic reference levels (DRL) for pediatric PTC and investigate the routine use of X-ray equipment. The study retrospectively analyzed data collected between October 2016 and June 2018 from a single center performing PTC. We collected exposure parameters including kerma area product (PKA), air kerma at patient entrance reference point (Ka,r) and fluoroscopy time via a dose archiving and communication system. Local diagnostic reference levels were derived as the 50th percentile of the distributions while considering published recommended weight groups. We investigated exposure variability with procedure complexity and with technical parameters recovered from the radiation dose structured report. The analysis included 162 PTC procedures performed in 64 children: 58% male, average age 6years (range 39days to 16years) and weight 24kg (range 3-60kg). Local DRLs for weight groups 0-5kg, 5-15kg, 15-30kg, 30-50kg and 50-80kg were, respectively, 6cGy.cm2, 22cGy.cm2, 68cGy.cm2, 107cGy.cm2 and 179cGy.cm2 in PKA. Local DRLs per weight group were also established for intermediate and complex procedures. Radiation dose structured report analysis highlighted good local practice with efficient collimation, low fluoroscopy pulse rate, no magnification and limited use of radiographic acquisitions. Meanwhile, table and detector positioning and tube projection could still be optimized. PKA correlated significantly with the number of acquisitions and tube-to-table distance. We established local DRLs for children undergoing PTC.

Tailored access to the hepatobiliary system in post-bariatric patients: a tertiary care bariatric center experience.

In bariatric surgery patients, pancreaticobiliary access via endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging and the optimal approach for the evaluation and treatment of biliary tree-related pathologies has been debated. Besides laparoscopy-assisted ERCP (LA-ERCP) as standard of care, EUS-directed transgastric ERCP (EDGE) and hepaticogastrostomy (HGS) with placement of a fully covered metal stent have emerged as novel techniques. The objective of this study was to evaluate safety and efficacy of three different endoscopic approaches (LA-ERCP, EDGE, and HGS) in bariatric patients. In this retrospective review, consecutive patients with Roux-en-Y gastric bypass (RYGB) and Sleeve Gastrectomy (SG) who underwent from 2013 to 2019 a LA-ERCP, an EDGE, or a HGS at a tertiary care reference center for bariatric surgery were analyzed. Patient demographics, type of procedure and indication, data regarding cannulation and therapeutic intervention of the common bile duct (procedure success), and clinical outcomes were analyzed. A total of 19 patients were included. Indications for LA-ERCP, EDGE, or HGS were mostly choledocholithiasis (78.9%) and in a few cases papillitis stenosans. Eight patients (57.1%) with LA-ERCP underwent concomitant cholecystectomy. Procedure success was achieved in 100%. Adverse events (AEs) were identified in 15.7% of patients (all ERCP related). All AEs were rated as moderate and there were no serious AEs. This case series indicates that ERCP via a transgastric approach (LA-ERCP, EDGE, or HGS) is a minimally invasive, effective, and feasible method to access the biliary tree in bariatric patients. These techniques offer an appealing alternative treatment option compared to percutaneous transhepatic cholangiography and drainage- or deep enteroscopy-assisted ERCP. In bariatric patients who earlier had a cholecystectomy, EUS-guided techniques were the preferred treatment options for biliary pathologies.

Percutaneous transhepatic cholangiography and drainage and endoscopic retrograde cholangiopancreatograph for hilar cholangiocarcinoma: which one is preferred?

both percutaneous transhepatic cholangiography and drainage (PTCD) and endoscopic retrograde cholangiopancreatography (ERCP) with SEMS implantation have been used for unresectable hilar cholangiocarcinoma (HC) in the clinic for many years. However, which one is preferred is still unknown. to study the effects of biliary drainage of self-expanding metal stents (SEMS) implantation under PTCD or ERCP to treat HC. the clinical data of 82 patients with HC from January 2006 to January 2015 were recorded retrospectively. Patients were treated with biliary implantation of self-expanding metal stents (SEMS) under PTCD (PTCD group, 40 patients) or ERCP (ERCP group, 42 patients). Clinical data, including total bilirubin concentrations, complications and survival time were analyzed. the remission of jaundice was similar in both groups (p > 0.05). The median survival time of the ERCP group and PTCD group were 237 d and 252 d respectively, with no significant differences (p > 0.05). The biliary infection rates under ERCP and PTCD procedure were 52.4 % and 20.0 % respectively, with a significant statistical difference (p < 0.05). For those HC patients of Bismuth III/IV, the infection rates under ERCP and PTCD procedure were 58.3 % and 14.3 %, respectively (p < 0.05). both PTCD and ERCP with SEMS implantation were effective to prolong the survival time of HC patients. The biliary infection rates were higher in the ERCP group, especially for Bismuth III/IV HC patients.

Biliary stricture after Roux-en-Y hepaticojejunostomy for bile duct injury–surgical challenge: a single-center expertise

Background Laparoscopic cholecystectomy has been considered the gold standard since the 1990. Yet the incidence of bile duct injury (BDI) has increased from 0.06 to 0.3% for open cholecystectomy to 0.5 to 1.4% when done laparoscopically. Roux-en-Y hepaticojejunostomy (RYHJ) is the most widely approved management for most post-cholecystectomy BDIs, yet some patients experience incapacitating biliary complications, such as jaundice or recurrent attacks of cholangitis, in addition to anastomotic stricture. Aim The aim of this study was to assess the short-term outcomes of a multidisciplinary approach regarding failed RYHJ after post-cholecystectomy BDI. Materials and methods A total of 15 patients were enrolled in the descriptive study after failure of RYHJ performed because of post-cholecystectomy BDI. Patients comprised six males and nine females. All patients after definitive treatment underwent follow-up by abdominal ultrasound and liver function tests for at least 11 months. Results One (6.7%) patient had liver transplantation because of liver cirrhosis. Four (26.7%) other cases were managed by revisionary surgery for the hepaticojejunostomy as the stricture was so tight. The reminder 10 cases underwent trial of percutaneous trans-hepatic cholangiography (PTC), but unfortunately six of them (40% of the whole group) failed to be dilated adequately, and they indeed underwent surgery, and the other four (26.7%) were dilated successful. During the follow-up, three (20%) patients had biliary leakage and two patients developed re-stricture, with one mortality because of pulmonary embolism. Conclusion Good long-term results can be achieved in patients with RYHJ stricture through a case-by-case analysis and an immediate multidisciplinary approach in expert hepatobiliary center.

The outcomes of biliary drainage by percutaneous transhepatic cholangiography for the palliation of malignant biliary obstruction in England between 2001 and 2014: a retrospective cohort study

IntroductionRelieving obstructive jaundice in inoperable pancreato-biliary cancers improves quality of life and permits chemotherapy. Percutaneous transhepatic cholangiography with drainage and/or stenting relieves jaundice but can be associated with significant morbidity...

Modern imaging modalities for diseases associated with obstructive jaundice syndrome

Obstructive jaundice (OJ) is a syndrome characterized by bile staining of the skin, mucous membranes, and sclera as a complication of pathological processes that lead to disruption of the bile ducts at various levels of the biliary tract. Obstructive jaundice represents various diseases with different onset, course, and outcome, as well as etiology, which implies the difficulties of the diagnostic process. Identification of a cholestasis cause and treatment of patients with OJ remain urgent and difficult tasks due to the steady rise in diseases of the hepatopancreatoduodenal zone (HPDZ) and the high frequency of diagnostic errors. The latter can lead to the progression of liver failure, as well as to the development of severe complications, which, in turn, are fatal. A significant role in detecting HPDZ pathology belongs to the radiological methods of studies, such as transabdominal ultrasonography (TUS), endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC), endoscopic ultrasound (EUS), intraductal ultrasonography (IDUS), magnetic resonance cholangiopancreatography (MRCP), helical computed tomography (hCT), and helical CT cholangiography (hCT-CG). However, it should be noted that, as of today, there is no well-established conventional radiological algorithm for determining the causes of biliary obstruction. This, in turn, leads to repeated or sequential inefficient administration of all possible methods of visualization, complicating the diagnostic algorithm. In this regard, it is advisable to perform an in-depth study of the Russian and foreign literature sources, highlighting the problem of an early and highly effective diagnostics of the causes of biliary obstruction in patients with OJ.