Future Directions of Percutaneous Biliary Interventions

Abstract

We are at an exciting cross-road in biliary interventions. While other services such as surgery and gastroenterology have learned to use imaging guidance to improve the safety and efficacy of their procedures, it is time for interventional radiologist to learn endoscopic interventions to achieve the same. The future of interventional radiologists in managing patients with biliary disease depends on (1) increasing comfort of our procedures, (2) publishing our data on biliary interventions, and (3) increasing collaboration with other services to manage biliary disease. We need to appropriately understand the limitations of interventional radiology to help guide the future directions of our specialty in this very interesting space.

Stepwise Percutaneous Approach to Treat Severe Benign Hepaticojejunostomy Stenosis

“…The SpyGlass Discover is a single-operator system with two working channels, is particularly designed for percutaneous procedures, and can provide additional helpful information to conventional fluoroscopy. 22,24 The cholangioscope is a 10.5-Fr system, and upsizing the biliary access is required to accept a larger sheath. Direct visualization of the wire and the anastomosis combined with fluoroscopy can lead to more successful canalization of the stricture orifice and decrease extraluminal access (►Fig.…”

Percutaneous creation of a choledocho-choledochostomy for intractable iatrogenic bile duct injury

“… 7 Restoration of bile duct continuity with either sharp recanalization or an RF wire can provide an alternative to major surgical repair of iatrogenic biliary injury, improving patient quality of life. 8 However, in all cases, the visualization of a distal target is required. 6 …”

“…7 Restoration of bile duct continuity with either sharp recanalization or an RF wire can provide an alternative to major surgical repair of iatrogenic biliary injury, improving patient quality of life. 8 However, in all cases, the visualization of a distal target is required. 6 A previous study on needle cannulation described the use of a 10 mm balloon as a visual target for the needle to advance via a Cope cannula (Cook Medical) in the left biliary system.…”