Percutaneous Endoscopic Biliary Stenting

Cho, Sung Won; Kim, Jin Hong; Hahm, Ki Baik; Yoo, Byeong Moo; Shin, Yong Joon; Bae, Won Yeop; Kim, Young Joon

Abstract

BACKGROUND AND AIMS: In malignant biliary obstruction, percutaneous endoscopic biliary stenting (PEBS) has been perfomed as a combined percutaneous-endoscopic method for conversion of percutaneous biliary drainage (PBD) into endoscopic biliary drainage (KBD). The aim of this study was to assess the clinical significance of PERS.
METHODS
The PEBS was performed to insert biliary stents in 20 cases for 18 patients (mean age 65.7 years, 10 males and 8 females) with unresectable malignant biliary obstruction (gallbladder cancer 5, pancreas cancer 2, Klastkin tumor 8, common bile duct cancer 1, ampullary cancer I, icteric hepatoma 1). A guidewire was advanced into the duodenum through a percutaneous route of PBD, trapped with a basket, and pulled out through the working channel of a duodenoscope. Based on this guidewire, the EBD was performed.
RESULTS
The reasons for performing the initial PBD were debilitated conditions such as sepsis in 7 cases and a failure of initial EBD in 13 cases (failure of selective cannulation of bile duct in 2, failure of guidewire insertion through the stenotic lesion in 3, and failure of guidewire insertion into the intrahepatic bile duct to be drained in 8). The biliary stents (a single plastic stent in 8, double plastic stents in 10, a single metallic stent in 2) were successfully inserted through the percutaneous route (PTBD in 19, T-tube in 1) with the PEBS method. No complications such as choleperitonitis, hemobilia, migration of stents, cholecystitis, or pancreatitis were observed.
CONCLUSIONS
PEBS is an easy and useful drainage method for conversion of PBD into EBD in unresectable malignant obstruction, when initial ERD is inappropriate.