Biliary Manometric Perfusion Test in the Evaluation of Benign Biliary Stricture Treatment - A Case Report

Abstract

Background: Benign biliary strictures treated radiologically by percutaneous dilatation treatment are usually evaluated by 'clinical test'. For objective evaluation of treatment success, measurement of the pressure inside the biliary tree has been proposed.Aim: The aim of this article is to report our experience with the measurement of the pressure in the biliary tree after treatment, to present the biliary manometric perfusion test (BMPT) as an alternative method of treatment evaluation and to demonstrate why the perfusion test is a better method of evaluation.Materials and Methods: A 65 year old lady with post operative biliary stricture and symptoms of jaundice was treated in our Department with percutaneous dilatation treatment and long-term drainage. The perfusion test (BMPT) was adopted for evaluating treatment success after the treatment for 9 months. An intrabiliary pressure less than 20 cms of water during perfusion test was considered success threshold.Results: The test was carried out without any complications and the pressure inside the biliary tree was less than 20 cms of water during the test. Eventually the drain was removed. On follow-up at 6 months the patient developed no recurrence of jaundice and the quality of life improved clinically. Periodic liver function tests during follow-up were normal. Conclusion:The perfusion test(BMPT) is promising effi cacious alternative method for the evaluation of radiological treatment of benign biliary strictures. It helps us to decide the end points in treatment and also helps in identifying patients who might later develop strictures.

Is the Biliary Manometric Perfusion Test Effective in the Evaluation of Balloon Dilatation Treatment Success of Benign Biliary Strictures?

“…Indications for hepaticojejunostomy were injury to bile ducts during laproscopic cholecystectomy in 9 patients, duodenopancreatectomy in 2 patients and resection of benign tumor in one patient. Six patients had symptoms of obstructive jaundice or obstructive jaundice and cholangitis, two patients had symp-R. P. Thomas After the initial transhepatic drainage, balloon dilatation and long term external internal drainage had been done for all patients according to the methodology percutaneous dilatation treatment described in literature 1,5,6 . Subsequently follow-up cholangiography usually after 6 months was performed.…”

“…1). We followed the specifically reported and validated technique of Savader et al [5][6][7][8] . The preexisting internal external biliary catheter was exchanged for a 9 or 10 F sheath which was left peripheral to the treated stenosis and was connected by tubing and a three way stop cock to a manometer and a standard angiography injector.…”

“…If all the pressure values during the perfusion test were less than 20 cm of water, the drain was removed and the patients were discharged. If pressure values were more than 20 cm of water, additional intervention was done by balloon dilatation and long term drainage for another 3 months 5,6 . Patients were followed up by gastroenterologists or surgeons for any symptoms of biliary obstruction.…”

“…For the objective evaluation of the treatment success, measurement of pressure inside the biliary tree (Biliary manometric perfusion test) has been proposed. We have earlier reported a case of biliary manometric perfusion test in a patient with benign biliary stricture and discussed the potential of the same in the treatment success evaluation 5 . The aim of this study was to assess the role of biliary manometric perfusion test (BMPT) in the evaluation of treatment success in a group of benign biliary stricture patients and to assess the long term biliary patency after treatment evaluation by manometric perfusion test.…”

“…When treated percutaneously, the typical sequence for determining treatment success and potential durability is the cholangiographic impression of the free flow of contrast medium across the treated stricture followed by the 'clinical test'. The clinical test involves leaving a small non functional 4 F safety catheter without side holes peripheral to or through the treated stenosis for a period of time (usually 7 to 10 days) and follow-up by liver function tests 5 . If the liver function tests are within the normal range, if the obstructive symptoms do not recur and bile leak from the percutaneous access is not seen, this suggests that the treated stricture will sustain prograde bile flow once the catheter is removed.…”