Percutaneous endoscopic gastrostomy/jejunostomy combined with percutaneous transhepatic biliary drainage in treating malignant biliary obstruction

To investigate the safety and efficacy of percutaneous endoscopic gastrostomy/jejunostomy [PEG/PEJ] combined with percutaneous transhepatic biliary drainage [PTCD] in treating malignant biliary obstruction. Nine patients [6 males and 3 females, average age 71.3 +/- 5.5 years] with complete obstruction of the biliary tract were treated with PEG/PEJ after PTCD. The PEG/PEJ and PTCD tubes were linked outside of the abdominal wall to direct the externally drained bile back to the jejunum through the PEG/PEJ intestinal tube. Clinical symptoms and liver function were assessed following the treatment. The operations were successfully completed in the 9 patients within 40 min [average 35 +/- 2.9 min]. Clinical symptoms such as jaundice, abdominal distension, stomachache and diarrhea appeared but improved within 7 days of the operation. Serum levels of bilirubin, aspartate aminotransferase and alanine aminotransferase were reduced [p < 0.01] 4 weeks following the treatment. There were no procedural complications. Combined PEG/PEJ and PTCD appeared to be safe and effective in the management of malignant biliary obstruction. Further, larger-scale studies will be needed to verify findings of this report

Clinical Feasibility and Usefulness of CT Fluoroscopy-Guided Percutaneous Transhepatic Biliary Drainage in Emergency Patients with Acute Obstructive Cholangitis

OBJECTIVE: To evaluate the feasibility of CT fluoroscopy (CTF)-guided percutaneous transhepatic biliary drainage (PTBD) in emergency patients with acute obstructive cholangitis. MATERIALS AND METHODS: The study included 28 patients admitted to the emergency center due to obstructive jaundice and found to require urgent biliary drainage, as well as judged to have a suitable peripheral bile duct for a CTF-guided puncture (at least 4 mm in width). Prior to the CTF-guided puncture, a CT scan was performed to evaluate bile duct dilatation and the underlying causes of biliary obstruction. If the patient was judged to be a suitable candidate, a CTF-guided PTBD was performed in the same CT unit without additional fluoroscopic guidance. Technical feasibility of the procedure was investigated with the evaluation of overall success rate and causes of failure. RESULTS: A hepatic puncture was attempted at the left lobe in 23 patients and right lobe in five patients. The procedure was successful in 24 of 28 patients (86%) Successful biliary puncture was achieved on the first attempt in 16 patients, the second attempt in five patients, and the third attempt in three patients. The causes of failure included guide wire twisting in one patient, biliary puncture failure in two patients, and poor visualization of the guide wire in one patient. There were no significant procedure-related complication. CONCLUSION: The CTF-guided PTBD is technically feasible and highly successful in patients judged to have a suitable indication. Moreover, although the procedure is unfamiliar and inconvenient to interventionalists, it has economical advantages in that it saves time and manpower. We believe this method can be used in the emergency patients requiring urgent biliary drainage as an alternative for the fluoroscopy-guided PTBD.

Manejo de stent metálico biliar obstruido en cáncer de páncreas: stent dentro de stent. Reporte de caso y revisión de la literatura / Management of obstructed metallic biliary stent in pancreatic cancer: stent within a stent. Case report and review of the literature

El cáncer de páncreas que produce ictericia obstructiva puede manejarse de manera temporal o definitiva si es inoperable con stents colocados endoscópicamente mediante colangio pancreatografía retógrada endoscópica o CPRE . Estos pueden ser plásticosteflonados de relativa corta duración (2 meses promedio) o definitivos metálicos. En el caso de los stents metálicos, los mismos son de malla metálica no cubierta y que pueden obstruirse por crecimiento de la neoplasia e invasión al lumen. Presentamos el caso de un paciente con stent metálico que cursa con colangitis por crecimiento tumoral. Se realiza un procedimiento de salvataje.

Pancreatic cancer producing obstructive jaundice can be handled temporarily orpermanently if it is inoperable with stents placed endoscopically by means of an endoscopic retrograde cholangio-pancreatography, or ERCP. These can be made of teflon plastic of relatively short duration (average 2 months) or permanent metallic ones. The metallicstents are made of non-covered metallic mesh that can be obstructed by the growth of the neoplasia and invasion of the lumen. We present the case of a patient with a metallic stentsuffering from cholangitis due to tumoral growth. A salvaging procedure was performed.