ECR 2013 Rec: Biliary procedures #SF14a #A445


A-445 Biliary procedures

M. Krokidis, A.A. Hatzidakis | Sunday, March 10, 14:00 – 15:30 / Room F1

Palliative Percutaneous Transhepatic Biliary Drainage (PTBD) is a therapeutic procedure leading to drainage of the obstructed bile duct system. If endoscopy is not possible and if patient is inoperable, then the percutaneous treatment is indicated. Drainage of the bile ducts is performed with a small plastic multiple hole pigtail catheter. Self-locking catheters are preferred in order to minimize the dislocation risk. The percutaneous catheter is pushed through the malignant stricture, so that bile is draining through the catheter towards the bowel loops. Technical success rate of percutaneous biliary drainage can reach nearly 100 % in experienced hands, while the major complications rate is usually lower than 5 %. Clinical efficacy is usually lower, but still over 90 %. The drainage procedure can be extended with the placement of a permanent metallic stent, which keeps the stenosed biliary duct patent, without need for a catheter. Metallic biliary stents have been proved as the best palliative treatment of non-resectable malignant obstructive jaundice, allowing longer patency rates than plastic endoprostheses. The technique is safe, with low-complication rate and procedure-related mortality between 0.8 and 3.4%. Still controversial remains in the timing between initial drainage and metallic stent placement, as well as the question of balloon dilatation before stent insertion. There is evidence that if the initial transhepatic drainage is completed without causing any severe complications, especially bleeding in form of haemobilia, primary metallic stenting can follow as a single-step procedure.



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