Abstract:

Aim: was to determine indications for transpapillary external-internal drainage of the biliary tree in benign diseases of the peripapillary region.

Material and methods: results of the use of externally-internally transpapillary drainage of the biliary tree from 256 patients with distal obstruction of the biliary tract were analyzed. In 154 (60,2%) cases the peripapillary obstruction was caused by tumor pathology, in 102(39,8%) cases (39.8 %) - by peripapillary benign stenotic diseases (stenosis of Vater papilla, choledocholithiasis, chronic pancreatitis, parapapillary diverticula) that have not managed to eliminate with the help of endoscopy or endoscopic benefit was initially ineffective.

Results: endoscopic papillosphincterotomy after the external-internal drainage due to syndrome of Vater papilla «acute blockage» required in 7(4,5%) patients of 154 patients with peripapillary tumor obstruction. Endoscopic papillotomy was performed in 80(78,4%) patients among 102 patients with benign distal block of common biliary duct after the external-internal drainage for same indications. In 7 cases of «acute blockage» of papilla we were forced to return to the outside cholangiostomy due to endoscopic unattainable of papilla. In summary, the syndrome of papilla «acute blockage» occurred in 87(85,3%) patients with transpapillary external- internal drainage of the biliary tree on the background of the peripapillary benign obstruction. There were no complications of papillotomy

Conclusion: the external-internal drainage of the biliary tree with the syndrome of obstructive jaundice remains an effective and pragmatic method of return of bile into the lumen of the duodenum. The most common complication of the external-internal drainage with transpapillary drainage placement is a syndrome of «acute blockage» of Vater papilla which requires endoscopic papillotomy With high frequency this syndrome occurs when forced transpapillary the external-internal drainage of the distal benign disorders of patency of the biliary tree. Minimal risk of this syndrome developing has been reported during transpapillary drainage in patients with obstructive jaundice due to peripapillary cancer.

References

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5.      Jo J.H., Park B.H. Suprapapillary versus transpapillary stent placement for malignant biliary obstruction: which is better? J Vasc Interv Radiol. 2015; 26(4):573-582.

6.      Lee D.H., Yu J.S., Hwang J.C., Kim K.H. Percutaneous placement of self-expandable metallic biliary stents in malignant extrahepatic strictures: indications of transpapillary and suprapapillary methods. Korean J Radiol. 2000;1(2):65-72.

Abstract:

From January 2003 till January 2008 transhepatic endobiliar stenting was performed in 62 patients with obstructive jaundice due to high post-operative malignant strictures of hepaticocholedochus duct. In 49 cases (79 %) two-step intervention performed (biliary drainage followed by endobiliary stenting), 13 patients (21 %) underwent single-stage intervention. In 60 patients (96,8%) balloon dilatation was done prior to stent implantation. In 59 cases (95,2%) the procedure was completed by control drainage placement. Hospital stay for the endobiliary stenting procedure was 12,7-22,3 days (average hospital stay 17,5 days). Mortality was as high as 12,9% (8 cases). Average post-implantation life span appeared to be 9,7 months. In 5 patients (8,1%) mechanical jaundice relapse occurred, so they needed hospitalization for reintervention. Direct dependence found between the effectiveness of endobiliary stenting and the technical characteristics of stents, anatomy of biliary strictures, as well as the methods and techniques of the intervention. Single-stage endobiliary stenting, without prior drainage, decreases the complication rate, improves the quality of life during the hospital stay, and prolongs the post-implantation life expectancy. Single-stege interventions are also shown to decrease the hospital stay and reduce the costs. Balloon dilatation is the required stage of the intervention, especially if self-expandable stents are used in torturous biliary ducts. Post-implantation drainage placement can be skipped if the wall of the hepatico-choledochus duct is not edematous, there are no signs of tumor prolapse into the lumen, if the stent is completely expanded, and the contrast media evacuates easily into the intestine.

Reference

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21.   Inal M., Aksungur E., Akgьl E. et al. Percutaneous Placement of Metallic Stents in Malignant Biliary Obstruction: One-Stage or Two-Stage Procedure? Pre-Dilate or Not? Cardiovasc. Intervent. Radiol. 2003; 26: 40-45.

Abstract:

We have retrospectively analyzed results of 100 patients’ interventional radiology methods in cases of difficulties during endoscopy choledocholithiasis treatment. It was determined that transcutaneous transhepatic cholangiostomy is a universal method of biliary decompression in case of dilatation of intrahepatic bile ducts, and can be the first stage of treatment in patients with choledocholithiasis which may be transformed consistently in endoscopic interventions, or – in case of its inefficiency or inexpediency may be transformed into percutaneous choledocholithotripsy and lithoextraction. The number of choledocholithotripsy and lithoextraction varied from 1 to 3 interference. Adequacy of lithoextraction from common bile duct was controlled by the repeated direct cholangioscopy and was confirmed by antegrade cholangiography. Complications of transhepatic method of choledocholithotripsy and lithoextraction included bacterial shock (6%), insignificant hemobilia (8%), migration (4%) and dislocation of cholangiostomy with disturbance of its drainage function (7%). Complications were eliminated successfully and didn’t change treatment tactic. There were no fatal outcomes in investigated group of patients. Antegrade percutaneous choledocholithotripsy and lithoextraction is the method of choice in case of impossibility of transpapillary endoscopical or traditional surgical treatment of choledoholithiasis.

References

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Abstract:

Hemobilia is known as one of the most severe complications of percutaneous transhepatic biliary drainage. In the present case, the severe bleeding developed as a result of balloon dilatation and stenting of malignant stricture. Emergency transhepatic arterial embolization was performed with good results. We also discuss 7 cases of hemobilia in our hospital, 3 of which were successfully treated with transcatheter embolotherapy. We conclude that transhepatic arterial embolization appears to be effective and safe treatment for massive hemobilia.

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Abstract:

Aim: was to estimate possibilities of optical coherence tomography (OCT) in diagnostics of pathology of bile ducts in combination with percutaneous transhepatic biliary drainage (PTBD).

Materials and methods: examined 5 patients with obstructive jaundice, suspected cancerous etiology OCT was performed during or 5-14 days after PTBD. For morphological confirmation of results we performed forceps intraductal biopsies.

Results: tomographic evidences of the malignant stricture were revealed in 4 (80%) patients anc in 1 patient benign stricture was determined. Diagnoses were confirmed histologically (80%) and clinically (20%). Sensitivity of the OCT was 100%.

Conclusion: percutaneous transhepatic OCT appeared to be a perspective method for differential diagnostics of biliary strictures. 

References

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Abstract:

Article describes the experience of X-ray-surgical treatment of patient with clinical and laboratory manifestations of cholestasis without a concomitant expansion of bile ducts. In anamnesis of disease - left-sided hemihepatectomy, hepaticojejunostomy on wireframe transhepatic drainage for treatment of portal cholangiocarcinoma III-b, 6 courses of adjuvant chemotherapy. Frame-drainage was removed after 6.5 months after surgery and 2 weeks before this hospitalization. Bilirubinemia (bilirubin 394.89 (233,00-161,89) mol/L) with signs dysproteinemia, cytolysis and anticoagulation were marked during the hospitalization. Lack of pneumobilia during sonography suggested that the most likely cause of cholestasis is a violation of the biliodigestive anastomosis patency Antegrade biliary decompression led to the development of hepatic failure, which was successfully treated by syndromic intensive therapy Following antegrade balloon dilatation of biliodigestive anastomosis area with its external-internal frame-drainage let us to eliminate clinical and laboratory manifestations of obstructive jaundice.

Conclusion: the need for a surgical biliary decompression in cancer patients with cholestasis without a significant expansion of bile ducts with a decrease of functional reserves of the liver is accompanied by the risk of development or progression of liver failure, which leads to complexity and ambiguity of the choice of treatment strategy in these patients.

References

1.    Yurchenko V.V. Javljaetsja li suprastenoticheskaja dilatacija objazatel'nym simptomom narushenija ottoka zhelchi? [Is suprastenotic dilatation a mandatory symptom of impaired bile outflow?] Vestnik rentgenologii i radiologii. 2015; 3: 18-22. [In Russ].