Percutaneous transhepatic management of biliary strictures in patients with dysfunctioning plastic biliary endoprostheses

Abstract

Background: To evaluate the safety and outcomes of percutaneous transhepatic management of dysfunctioning plastic biliary endoprostheses (PBE) in patients with benign/malign biliary strictures.

Methods: Twenty-nine patients (22 men, 7 women; mean age of 60.7 (range 33-88) years) diagnosed with dysfunctioning PBE were included. Percutaneous transhepatic biliary drainage and subsequent PBE dislodgment into the bowel were performed in all cases. Patient demographics, etiology of the biliary stricture, indication, technical success, complications, and clinical outcomes were gleaned from medical records.

Results: Seventeen patients had malignant strictures, while 12 patients had benign conditions. A total of 36 PBE (33 straight, 3 double-J) were treated. Six patients had more than one PBE. Successful dislodgement of the PBE was achieved in 28 (96.6%) of the cases. Monorail threading was performed in 8 cases while dislodgement by balloon friction was utilized in 21 patients. There was no statistical significance between benign and malignant biliary strictures regarding dislodgement duration (p = 0.080). No major complication was encountered. Thirteen minor complications in 10 patients including abdominal pain (n = 8) and mild hemobilia (n = 5) were observed and treated conservatively. Uneventful passage of the PBE was reported by all patients with technical success.

Discussion: Percutaneous transhepatic methods aid as a reasonable alternative in the treatment of benign and malignant biliary strictures in patients with dysfunctioning PBE when endoscopic approaches fail or are not eligible.

Keywords: : Plastic biliary endoprostheses; benign biliary stricture; malignant biliary stricture; percutaneous transhepatic biliary drainage.

Figure 1

A 84-year-old male with a history of pancreatic adenocarcinoma was admitted with jaundice and pain. a, b. The right bile duct was catheterized and cholangiogram revealed proximal migration and impaction of the plastic biliary endoprostheses (PBE) c, d. Guidewire was passed through the distal side hole of the PBE and monorail threading with a 5F diagnostic catheter was performed to dislodge the PBE into the duodenum. e, f. Endobiliary RFA and metallic stenting were adjusted. Completion cholangiogram shows free contrast media passage.

Figure 2

A 67-year-old man with a history of liver transplantation presented with jaundice, fever, pruritus. a. Cholangiogram after catheterization of the right bile duct depicts occlusion at the hilar level and distal placement of the plastic biliary endoprostheses (PBE) in the common bile duct. b. Dislodgement by friction was performed subsequent to balloon inflation just proximal to the PBE. c, d. Balloon angioplasty was performed with 10–12 mm balloons in multiple sessions and completion cholangiogram shows resolution of the stenosis and free passage of the contrast media.