Single-Phase Percutaneous Recanalization of Malignant Bile Duct Obstructions with a Covered Stent Graft

Abstract

Purpose: The aim of this study was to evaluate the benefit of a percutaneous transhepatic biliary drainage (PTCD) endoprothesis in the case of patients with malignant occlusion of the common bile duct (CBD).

Materials and Methods: 32 patients (mean age 72 ± 13 years) were treated with an endoprosthesis (VIABIL; M. L. GORE & ASSOCIATES, INC., USA) due to failed attempts of endoscopic retrograde cholangiopancreatography (ERCP) in the case of malignant occlusion of the CBD.

Results: The technical success rate was 96.9 %. In one patient the probing of an intrahepatic bile duct was impossible. Two major complications (bleeding, liver abscess) were successfully treated with appropriate measures. The bilirubin level did not significantly decrease immediately after intervention (13.2 ± 6.5 mg/dl; p > 0.05). However, the follow-up displayed a highly significant decrease of bilirubin to 6.0 ± 7.4 mg/dl; p < 0.05). The endoprosthesis was extended with bare metal NITINOL stents in 9 patients. The mean survival time of the patient group was 64 ± 28 days (range 2 – 250 days).

Conclusion: The implantation of an endoprosthesis proved to be an option with high technical success, a low complication rate and good benefit in our patients with malignant bile duct obstruction in palliative therapy situations.

Key Points:

• The primary objective in the case of malignant bile duct obstruction is the treatment of jaundice.

• After failed endoscopic recanalization of the bile ducts, transhepatic biliary drainage is desirable.

• An ePTFE-FEP covered endoprothesis is a good treatment option in palliative situations.

• A single-stage procedure shortens hospitalization time.

Citation Format:

• Scheer F, Wissgott C, Lüdtke CW et al. Single-Phase Percutaneous Recanalization of Malignant Bile Duct Obstructions with a Covered Stent Graft. Fortschr Röntgenstr 2014; 186: 394 – 399

Zusammenfassung

Ziel: Ziel dieser retrospektiven Studie war es, den Benefit einer perkutan transhepatisch implantierten Endoprothese bei Patienten mit tumorbedingter Stenose des DHC und palliativer Therapiesituation zu evaluieren.

Material und Methoden: Bei 32 Patienten (mittleres Alter 72 ± 13 Jahre) mit kausal maligner Okklusion des Ductus choledochus (DHC) und frustranem Versuch der endoskopischen retrograden Cholangiopancreaticografie (ERCP) wurde die Indikation zur perkutanen transhepatischen Cholangiodrainage (PTCD) und Implantation einer Endoprothese (VIABIL der Firma M. L. GORE & ASSOCIATES, INC., USA) gestellt.

Ergebnisse: Die technische Erfolgsrate lag bei 96,9 %. Bei einem Patient war die Sondierung eines intrahepatischen Gallengangs nicht möglich. Zwei Majorkomplikationen (Nachblutung, Leberabszess) konnten durch entsprechende Maßnahmen erfolgreich behandelt werden. Der Gesamtbilirubin war mit 13,2 ± 6,5 mg/dl unmittelbar postinterventionell nicht signifikant erniedrigt (p > 0,05). Im Follow-up zeigte sich jedoch eine signifikante Erniedrigung des Gesamtbillirubin auf 6,0 ± 7,4 mg/dl (p < 0,05). Bei 9 Patienten wurde die Stentprothese mittels Baremetal Nitinolstents verlängert. Die mittlere Überlebenszeit des Patientenkollektivs lag bei 62 ± 71 Tagen (range: 2 – 250 Tage).

Schlussfolgerung: Die interventionelle Implantation einer Endoprothese stellt bei Patienten mit maligner Gallengangsobstruktion in einer palliativen Therapiesituation und frustaner endoskopischer Sondierung eine Option mit gutem Benefit dar.

Key words

bile ducts - bile duct radiography - stents - drainage - interventional procedures - percutaneous

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