A combined endoscopic and radiological method for biliary drainage

A Combined Percutaneous Endoscopic Placement of Biliary Stent for Malignant Obstructive Jaundice: “A Few Practical Hints Make it Safe”

“…Endoscopic insertion of a draining biliary endoprosthesis is a very effective and reasonably safe method, but it has a failure rate around 15% [6,7], which could be due to different anatomic abnormalities, e.g., periampullary diverticulum, duodenal encasement by the tumor, or if biliary enteric surgery has been previously performed (e.g., Billroth II, Roux-en-Y gastrojejunostomy, choledochojejunostomy, etc.). However, in most cases technical failure might result from inability to pass either the guidewire or a large stent beyond the stricture [7,8].…”

“…However, in most cases technical failure might result from inability to pass either the guidewire or a large stent beyond the stricture [7,8]. Percutaneous transhepatic drainage (PTD) of the biliary tree is an alternative method to decompress the obstructed biliary tree and to insert a draining stent.…”

“…However, it carries a relatively higher morbidity. Its complications include hemorrhage, leakage of bile into the peritoneal cavity leading to bile/ bacterial peritonitis, and in the long run, the catheter might be dislodged or occluded [7,8]. On the other hand, placement of a large stent through the percutaneous transhepatic route is very painful and might lead to serious complications due to vascular trauma [7][8][9].…”

Percutaneous Biliary Drainage with Emphasis on Hilar Lesions

“…'Turf battles have been overcome in part by the introduction of combined radio I og ic-e ndosco pi c procedures ( 14,15). Furthermore, a host of new applications has been developed.…”

“…IBD catheter is retrieved by a basket under endoscopic guidance and the cndoprosthesis placed in a similar manner (14,94). A third method, which is often used in the author's Jepartment, is for the endoscop ist co place a wire alongside the rn IBD catheter ( Figure 7).…”