Percutaneous management of occluded biliary duct endoprostheses

Abstract

Purpose: To present interventional methods for percutaneous treatment of patients with occluded bile duct endoprostheses.

Material and Methods: Thirteen patients with endoscopically inserted occluded or damaged bile duct endoprostheses and recurrent jaundice were treated percutaneously. Endoscopic treatment was not available in 2 cases and unsuccessful in 11 other patients. Eleven interventions were performed under systemic sedation and local anaesthesia and 2 under general anaesthesia. The endoprostheses were dislodged to the bowel using different interventional devices. Adequate bile duct drainage was subsequently achieved by insertion of self-expanding metallic stents.

Results: All procedures were accomplished successfully and without immediate serious complications. Two metallic stents and 18 plastic endoprostheses were dislodged to the bowel using percutaneous interventional techniques. One plastic endoprosthesis became bent in the duodenum and had to be removed endoscopically due to abdominal pain. None of the other endoprostheses left in the bowel caused any symptoms. Two patients died during the first week after the procedure due to progressive liver failure.

Conclusion: Occluded bile duct endoprostheses can be safely dislodged to the bowel and replaced by metallic stents using percutaneous interventional techniques.