J Korean Soc Radiol.  2013 Nov;69(5):385-390. 10.3348/jksr.2013.69.5.385.

Percutaneous Transhepatic Recanalization of Malignant Hilar Obstruction: A Possible Rescue for Early Failure of Endoscopic Y-Stenting

• Kwon H
• Kim CW
• Lee TH
• Jeon UB
• Kim S
• Kim DU
• Kang DH

• KMID: 2002860
• DOI: http://doi.org/10.3348/jksr.2013.69.5.385

Abstract

PURPOSE
Endoscopic biliary stenting is well known as an optimal method of management of malignant hilar obstruction, but sometimes the result is not satisfactory, with early stent failure. Percutaneous transhepatic biliary drainage (PTBD) has a distinct advantage over endoscopic retrograde cholangiopancreatoscopy in that with ultrasound guidance one or more appropriate segments for drainage can be chosen. We evaluated the effectiveness of percutaneous transhepatic stenting as a rescue of early failure of endoscopic stenting.
MATERIALS AND METHODS
Ten patients (4 men, 6 women; age range, 52-78 years; mean age, 69 years) with inoperable biliary obstruction (2 patients with gall bladder cancer and hilar invasion, and 8 patients with Klatskin tumor) and with early endoscopic stent failure were included in our study. All of the patients underwent PTBD and percutaneous transhepatic biliary stenting. Metallic stents were placed in all patients for internal drainage.
RESULTS
Percutaneous rescue stenting was successful in all the patients technically and clinically. Mean time for the development of biliary obstruction was 13.5 days after endoscopic stenting. The mean patency of the rescue stenting was 122 days. The mean survival time for percutaneous transhepatic rescue stenting was 226.3 days.
CONCLUSION
In early failure of endoscopic biliary stenting, percutaneous transhepatic recanalization can be a possible solution.

MeSH Terms

Dioxolanes
Drainage
Female
Fluorocarbons
Gallbladder Neoplasms
Humans
Male
Stents
Survival Rate
Ultrasonography
Dioxolanes
Fluorocarbons

Figure

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  Fig. 1 Patient 1, 68-year-old female, gall bladder (GB) cancer with hilar invasion, Bismuth IIIA obstruction. A. Coronal T2-weighted MR image shows GB mass with hilar invasion. B. Cause of endoscpopic stent failure was second stent (endoscopic Y-stent) insertion failure. Cholangiogram shows obstruction of right hepatic duct. C. The stricture was negotiated with the use of guide wire and catheter technique. Cholangiogram shows passage of the guide wire. D. After passage of the guidewire, a balloon catheter was used for dilatation of stricture. E. Rescue stenting was performed by Niti-D 10/70 mm. Final cholangiogram shows good communication of the whole biliary system.

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  Fig. 2 Patient 6, 63-year-old female, Klatskin tumor, Bismuth IV. A. Coronal T2-weighted MR image shows hilar mass with prominent bile duct dilatation. B. Cholangiogram shows obstruction of right hepatic duct and malposition of endoscopic Y-stent in B4 and left hepatic duct. C. Rescue stenting was performed by Luminexx 10/80 mm.

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