Percutaneous Transhepatic Dilatation in the Management of Bile Duct Strictures

Little, J. M.; Wong, Kai Pun; Simmons, K. C.

doi:10.1111/j.1445-2197.1986.tb02376.x

Cited by 10 publications

(5 citation statements)

References 8 publications

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“…Biliary stricture, with or without the presence of ductal angulation, becomes a great challenge to surgeons in the management of hepatolithiasis [3,8,[14][15][16][17][18][19]. In Taiwan, biliary strictures are found in 90% of cases [l], while, in Japan and in Singapore, strictures are found in only half of the cases [i].…”

Section: Discussionmentioning

confidence: 99%

“…Massive bleeding occurred on the fourth PTCD track establishment from the posterior approach. It reminds us that the possibility of coexistent malignancies should be kept in mind when the location of biliary strictures and retained calculi are unusual [14,19].…”

Section: According To the Ie Classification [(I) Intrahepatic And (E)mentioning

confidence: 93%

“…Its advantages include: ready access by direct percutaneous approach to areas where stones are difficult to locate, providing an adequate overview of the whole biliary tree during choledochoscopy, and affording repeated performances until success is achieved. It also facilitates simultaneous or associated procedures such as balloon dilatation of biliary strictures [8,[12][13][14], crushing of impacted stones by electrohydraulic lithotripsy (EHL) [8,[15][16], and cholangiobiopsy [12,13,17]. The success rate of stone eradication by PTCS is reported to be as high as 68% to 80% [8,13], but complications are rarely presented.…”

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confidence: 99%

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Limitations of percutaneous transhepatic cholangioscopy in the removal of complicated biliary calculi

1989

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To investigate the limitations of percutaneous transhepatic cholangioscopic lithotomy (PTCSL) in the management of retained or reformed biliary calculi, we conducted a retrospective study of 50 patients who had received PTCSL for complicated biliary calculi during a period of 32 months. The calculi were located in the common bile duct (24%), the intrahepatic bile ducts (60%), and in both the common bile duct and intrahepatic bile ducts (16%). The adjunctive techniques in PTCSL included balloon dilatation for the biliary stricture, electrohydraulic lithotripsy (EHL) for crushing large impacted stones, and flushing techniques, biliary spoons, and basket catheters for stone fragmentation and grasping. The overall percutaneous manipulations totaled 221 procedures, including 124 sessions of PTCS. In each patient, the number of sessions of PTCS varied from 1 to 7. In our series, the main complications of PTCS therapy, rarely reported in the literature, included pain intolerance in 7 cases (14%), minor bleeding in 7 cases (14%), and massive bleeding which needed angiographic diagnosis and therapy for hemostasis in 5 cases (10%). Secondary biliary cirrhosis, severe biliary stricture and angulations, previous shunt surgery, neovascularization surrounding the chronic inflammatory stenotic intrahepatic bile ducts, pseudoaneurysm formation, and coexistent cholangiocarcinoma contributed to the vulnerability of bleeding during manipulations. The complications resulted in treatment failure in 11 patients (22%). We conclude that PTCS is a useful alternative treatment to surgery for biliary calculi, but it has limitations that obviate complete stone clearance.

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Section: Discussionmentioning

confidence: 99%

Section: According To the Ie Classification [(I) Intrahepatic And (E)mentioning

confidence: 93%

mentioning

confidence: 99%

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Limitations of percutaneous transhepatic cholangioscopy in the removal of complicated biliary calculi

1989

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“…Intrahepatic biliary stricture, with or without the presence of ductal angulation, is a great difficulty to surgeons in the management of hepatolithiasis [1][2][3][4][5][6][7][8][9][10]. It is a main cause of treatment failure for conventional surgery and choledochoscopic stone removal, and is also the main cause of stone recurrence.…”

mentioning

confidence: 99%

Dilatation of intrahepatic biliary strictures in patients with hepatolithiasis

et al. 1990

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To investigate the role of balloon dilatation in the management of complicated hepatolithiasis with intrahepatic biliary stricture, 57 consecutive patients who received 208 sessions of dilatation in addition to the usual treatment were analyzed. The strictures were located in the right intrahepatic ducts (84.2%), left intrahepatic ducts (12.3%), or both (3.5%). Dilatation began 3-4 weeks after surgery. The routes of dilatation included the matured T-tube tract (3 cases), percutaneous transhepatic biliary drainage tracts (42 cases), and both (12 cases). The immediate overall success rate of complete stone clearance increased significantly from 0% predilatation to 94.7% postdilatation. The main complications of dilatation therapy consisted of septicemia (10.5%), hemobilia (10.5%), and mild diarrhea (80%). Eight patients (14%) with long-segment strictures received 11 postdilatation biliary stentings. Complications were 1 patient with occlusion and 2 patients with "spontaneous" hemobilia. Severe multiple strictures and coexistent secondary biliary cirrhosis were the contributing factors to complications. During the follow-up of 3.4 +/- 1.2 years, recurrence of strictures was found in 4 patients. Two of them belonged to the stenting group. The cumulative probability of restricture was low: 4% at 2 years, 6% at 2.5 years, and 8% at 3 years. We conclude that in complicated cases of hepatolithiasis with intrahepatic biliary stricture, dilatation and stenting are good adjuvant therapies.

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“…current hepatolithiasis and biliary strictures. [1][2][3][4][5] With percutaneous transhepatic manipulations, including percutaneous stricture dilatation (PSD) and subsequent percutaneous transhepatic cholangioscopic lithotomy (PTCSL), [26][27][28][29][30] major surgical procedures are usually avoided. After balloon dilatation therapy for the strictures and repeated clearance of the stones, biliary stenting therapy is necessary for some patients with difficult strictures to maintain the ductal lumen at a minimum diameter because of the high potential for stricture recurrence.…”

Section: Methodsmentioning

confidence: 99%

Are Expandable Metallic Stents Better Than Conventional Methods for Treating Difficult Intrahepatic Biliary Strictures With Recurrent Hepatolithiasis?

Jeng

Sheen²,

Yang³

1999

Arch Surg

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Background: Conventional methods for treating patients with recurrent hepatolithiasis associated with complicated intrahepatic biliary strictures include balloon dilatation of the intrahepatic biliary strictures, lithotripsy, and the clearance of difficult stones as completely as possible, with the placement of an external-internal stent for at least 6 months. After these modalities are used, symptomatic refractory strictures remain. Recently we used internal Gianturco-Rosch metallic Z stents to treat patients who had refractory strictures. Objective: To compare therapeutic results and complications of an internal expandable metallic Z stent with those of repeated external-internal stent placement.

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Percutaneous Transhepatic Dilatation in the Management of Bile Duct Strictures

Cited by 10 publications

References 8 publications

Limitations of percutaneous transhepatic cholangioscopy in the removal of complicated biliary calculi

Limitations of percutaneous transhepatic cholangioscopy in the removal of complicated biliary calculi

Dilatation of intrahepatic biliary strictures in patients with hepatolithiasis

Are Expandable Metallic Stents Better Than Conventional Methods for Treating Difficult Intrahepatic Biliary Strictures With Recurrent Hepatolithiasis?

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