ABSTRACT
PURPOSE: To review the frequency and success of percutaneous and endoscopic techniques in the relief of high biliary obstruction. MATERIALS AND METHODS: A search of the radiologic achieves was performed identifying 70 patients with cholangiographic demonstration of high biliary obstruction defined as proximal to the distal third of the extrahepatic bile duct. Record review determined the frequency and success rates of percutaneous and endoscopic techniques in providing biliary decompression for obstructive jaundice. RESULTS: Endoscopic retrograde cholangiopancreatography was performed in 35 of 70 patients, providing initial endoscopic biliary decompression (EBD) in six patients (two subsequently required percutaneous intervention). Percutaneous biliary drainage (PBD) was attempted in 60 of 70 patients, providing initial decompression in 55 patients. PBD provided decompression after failed endoscopic biliary drainage in 18 of 26 patients. Endoscopic drainage was never attempted after failed percutaneous drainage. Overall EBD success was 23% and overall PBD success was 95%. The complication rate attributed to EBD was 26%; that attributed to PBD was 25%. For those patients who underwent attempts at both EBD and PBD, the complication rate was 16%. CONCLUSION: At an institution with well-developed gastrointestinal medical services and interventional radiologic services, PBD was more successful in providing initial biliary decompression than endoscopic techniques for high biliary obstruction.
Subject(s)
Cholestasis, Extrahepatic/therapy , Adult , Aged , Aged, 80 and over , Bile Duct Neoplasms/complications , Bile Ducts, Intrahepatic , Carcinoma/complications , Catheterization/adverse effects , Cholangiocarcinoma/complications , Cholangiography , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Cholestasis, Extrahepatic/etiology , Cholestasis, Extrahepatic/surgery , Drainage/adverse effects , Drainage/methods , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pancreatic Neoplasms/complications , Retrospective Studies , Treatment OutcomeABSTRACT
We attempted to determine the feasibility, safety, and success of transrectal catheter drainage of deep pelvic abscesses using a combination of transrectal sonography and fluoroscopic guidance. In this retrospective review of five cases, transrectal catheters were placed within abscess cavities over a 20 month period. Clinical improvement was prompt, catheters were removed within 7 days, and no complications were detected. No patient required further intervention (follow-up 2 to 20 months). Transrectal sonographically guided catheter drainage proved to be safe and effective in our series. This method is a promising alternative to the posterior (sciatic notch) approach when the anterior transabdominal approach is contraindicated.
