Use of a modified angioplasty balloon catheter in the dilatation of tight biliary strictures.

Abstract

Nineteen biliary strictures were dilated using a modified angioplasty balloon catheter to allow insertion of a IOF prosthesis. In each instance biliary strictures were successfully dilated which had previously been too tight to widen with standard endoscopic biliary dilating catheters. Eleven patients had malignant hilar strictures, four malignant distal common bile duct strictures, and four benign strictures. There were no complications as a result of the procedure and satisfactory biliary drainage was established in all patients. We conclude that tight biliary strictures can be successfully dilated using a modified angioplasty balloon catheter.Endoscopic insertion of a prosthesis to drain a malignant biliary obstruction appears to be just as effective as a surgical bypass procedure.' In addition a recent trial indicates that the endoscopic approach may be safer.' In addition to the usual endoscopic difficulties experienced in selectively cannulating the biliary tree,4 we have found that one of the major obstacles to successful insertion of a biliary prosthesis is the resistance to dilatation of very tight biliary strictures despite the use of standard biliary dilators. In the past year we have investigated the value of the Olbert endoscopic balloon dilating catheter* for dilating biliary strictures which we found impossible to dilate using standard biliary dilators. Methods PATIENTSOver a 12 month period we dilated very tight biliary strictures in 19 patients (13 women). The mean age was 68 years, range 31 to 93. All patients were shown to have mechanical obstruction of the biliary tree by ultrasound examination. The nature and the site of the obstruction were further clarified by detailed cholangiography during endoscopic retrograde cholangiopancreatography (ERCP). Of the 15 patients with malignant biliary obstruction 11 had hilar lesions and the remaining four had lower common bile duct strictures. Four patients had benign strictures.The patients were admitted the day before the procedure. After obtaining informed consent from each patient, the platelet count, white cell count, and prothrombin time were measured and 2 U blood were cross matched. Ampicillin