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Semin intervent Radiol 2017; 34(04): 361-368
DOI: 10.1055/s-0037-1608827
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Palliative Percutaneous Biliary Interventions in Malignant High Bile Duct Obstruction

Amy R. Deipolyi
1   Department of Radiology, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, New York, New York
,
Anne M. Covey
1   Department of Radiology, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, New York, New York
› Author Affiliations
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Publication History

Publication Date:
14 December 2017 (online)

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Abstract

The optimal palliative intervention for malignant biliary obstruction is internal drainage by placement of a metallic stent. For patients with hilar biliary obstruction or low bile duct obstruction in whom endoscopy is not feasible, a percutaneous transhepatic approach in interventional radiology is preferred. This article reviews the rationale for this approach, periprocedural management, and techniques to optimize stent patency.

Keywords

interventional radiology - biliary obstruction - bile duct obstruction - stent - biliary drainage
 

  • References

  • 1 Shepherd HA, Royle G, Ross AP, Diba A, Arthur M, Colin-Jones D. Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: a randomized trial. Br J Surg 1988; 75 (12) 1166-1168
    CrossrefPubMedGoogle Scholar
  • 2 Smith AC, Dowsett JF, Russell RC, Hatfield AR, Cotton PB. Randomised trial of endoscopic stenting versus surgical bypass in malignant low bile duct obstruction. Lancet 1994; 344 (8938): 1655-1660
    CrossrefPubMedGoogle Scholar
  • 3 Covey AM, Brown KT. Palliative percutaneous drainage in malignant biliary obstruction. Part 2: Mechanisms and postprocedure management. J Support Oncol 2006; 4 (07) 329-335
    PubMedGoogle Scholar
  • 4 Wright BE, Cass OW, Freeman ML. ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla. Gastrointest Endosc 2002; 56 (02) 225-232
    CrossrefPubMedGoogle Scholar
  • 5 Covey AM, Brown KT. Palliative percutaneous drainage in malignant biliary obstruction. Part 1: indications and preprocedure evaluation. J Support Oncol 2006; 4 (06) 269-273
    PubMedGoogle Scholar
  • 6 Abraham NS, Barkun JS, Barkun AN. Palliation of malignant biliary obstruction: a prospective trial examining impact on quality of life. Gastrointest Endosc 2002; 56 (06) 835-841
    CrossrefPubMedGoogle Scholar
  • 7 Robson PC, Heffernan N, Gonen M. , et al. Prospective study of outcomes after percutaneous biliary drainage for malignant biliary obstruction. Ann Surg Oncol 2010; 17 (09) 2303-2311
    CrossrefPubMedGoogle Scholar
  • 8 Saluja SS, Gulati M, Garg PK. , et al. Endoscopic or percutaneous biliary drainage for gallbladder cancer: a randomized trial and quality of life assessment. Clin Gastroenterol Hepatol 2008; 6 (08) 944-950.e3
    CrossrefPubMedGoogle Scholar
  • 9 Ring EJ, Kerlan Jr RK. Interventional biliary radiology. AJR Am J Roentgenol 1984; 142 (01) 31-34
    CrossrefPubMedGoogle Scholar
  • 10 Patel IJ, Davidson JC, Nikolic B. , et al; Standards of Practice Committee, with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol 2012; 23 (06) 727-736
    CrossrefPubMedGoogle Scholar
  • 11 Westphal JF, Brogard JM, Caro-Sampara F. , et al. Assessment of biliary excretion of piperacillin-tazobactam in humans. Antimicrob Agents Chemother 1997; 41 (08) 1636-1640
    CrossrefPubMedGoogle Scholar
  • 12 Venkatesan AM, Kundu S, Sacks D. , et al; Society of Interventional Radiology Standards of Practice Committee. Practice guidelines for adult antibiotic prophylaxis during vascular and interventional radiology procedures. [corrected] J Vasc Interv Radiol 2010; 21 (11) 1611-1630 , quiz 1631
    CrossrefPubMedGoogle Scholar
  • 13 Mueller PR, Ferrucci Jr JT, vanSonnenberg E. , et al. Obstruction of the left hepatic duct: diagnosis and treatment by selective fine-needle cholangiography and percutaneous biliary drainage. Radiology 1982; 145 (02) 297-302
    CrossrefPubMedGoogle Scholar
  • 14 Winick AB, Waybill PN, Venbrux AC. Complications of percutaneous transhepatic biliary interventions. Tech Vasc Interv Radiol 2001; 4 (03) 200-206
    CrossrefPubMedGoogle Scholar
  • 15 McNicholas MM, Lee MJ, Dawson SL. , et al. Complications of percutaneous biliary drainage and stricture dilatation. Semin Intervent Radiol 1994; 11: 242-253
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Thornton RH, Ulrich R, Hsu M. , et al. Outcomes of patients undergoing percutaneous biliary drainage to reduce bilirubin for administration of chemotherapy. J Vasc Interv Radiol 2012; 23 (01) 89-95
    CrossrefPubMedGoogle Scholar
  • 17 Eklund JW, Trifilio S, Mulcahy MF. Chemotherapy dosing in the setting of liver dysfunction. Oncology (Williston Park) 2005; 19 (08) 1057-1063 , discussion 1063–1064, 1069
    PubMedGoogle Scholar
  • 18 Piñol V, Castells A, Bordas JM. , et al. Percutaneous self-expanding metal stents versus endoscopic polyethylene endoprostheses for treating malignant biliary obstruction: randomized clinical trial. Radiology 2002; 225 (01) 27-34
    CrossrefPubMedGoogle Scholar
  • 19 Mansour JC, Aloia TA, Crane CH, Heimbach JK, Nagino M, Vauthey JN. Hilar cholangiocarcinoma: expert consensus statement. HPB 2015; 17 (08) 691-699
    CrossrefPubMedGoogle Scholar
  • 20 Beddy P, Ryan JM. Antibiotic prophylaxis in interventional radiology--anything new?. Tech Vasc Interv Radiol 2006; 9 (02) 69-76
    CrossrefPubMedGoogle Scholar
  • 21 Okamoto T, Fujioka S, Yanagisawa S. , et al. Placement of a metallic stent across the main duodenal papilla may predispose to cholangitis. Gastrointest Endosc 2006; 63 (06) 792-796
    CrossrefPubMedGoogle Scholar
  • 22 Brody LA, Brown KT, Getrajdman GI. , et al. Clinical factors associated with positive bile cultures during primary percutaneous biliary drainage. J Vasc Interv Radiol 1998; 9 (04) 572-578
    CrossrefPubMedGoogle Scholar
  • 23 Kloek JJ, van der Gaag NA, Aziz Y. , et al. Endoscopic and percutaneous preoperative biliary drainage in patients with suspected hilar cholangiocarcinoma. J Gastrointest Surg 2010; 14 (01) 119-125
    CrossrefPubMedGoogle Scholar
  • 24 Paik WH, Park YS, Hwang JH. , et al. Palliative treatment with self-expandable metallic stents in patients with advanced type III or IV hilar cholangiocarcinoma: a percutaneous versus endoscopic approach. Gastrointest Endosc 2009; 69 (01) 55-62
    CrossrefPubMedGoogle Scholar
  • 25 Walter T, Ho CS, Horgan AM. , et al. Endoscopic or percutaneous biliary drainage for Klatskin tumors?. J Vasc Interv Radiol 2013; 24 (01) 113-121
    CrossrefPubMedGoogle Scholar
  • 26 Chang WH, Kortan P, Haber GB. Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage. Gastrointest Endosc 1998; 47 (05) 354-362
    CrossrefPubMedGoogle Scholar
  • 27 Rerknimitr R, Kladcharoen N, Mahachai V, Kullavanijaya P. Result of endoscopic biliary drainage in hilar cholangiocarcinoma. J Clin Gastroenterol 2004; 38 (06) 518-523
    CrossrefPubMedGoogle Scholar
  • 28 Jo JH, Park BH. Suprapapillary versus transpapillary stent placement for malignant biliary obstruction: which is better?. J Vasc Interv Radiol 2015; 26 (04) 573-582
    CrossrefPubMedGoogle Scholar
  • 29 Thornton RH, Frank BS, Covey AM. , et al. Catheter-free survival after primary percutaneous stenting of malignant bile duct obstruction. AJR Am J Roentgenol 2011; 197 (03) W514-8
    CrossrefPubMedGoogle Scholar
  • 30 Hann LE, Getrajdman GI, Brown KT. , et al. Hepatic lobar atrophy: association with ipsilateral portal vein obstruction. AJR Am J Roentgenol 1996; 167 (04) 1017-1021
    CrossrefPubMedGoogle Scholar
  • 31 Takayasu K, Muramatsu Y, Shima Y, Moriyama N, Yamada T, Makuuchi M. Hepatic lobar atrophy following obstruction of the ipsilateral portal vein from hilar cholangiocarcinoma. Radiology 1986; 160 (02) 389-393
    CrossrefPubMedGoogle Scholar
  • 32 Sofue K, Arai Y, Takeuchi Y, Fujiwara H, Tokue H, Sugimura K. Safety and efficacy of primary metallic biliary stent placement with tract embolization in patients with massive ascites: a retrospective analysis of 16 patients. J Vasc Interv Radiol 2012; 23 (04) 521-527
    CrossrefPubMedGoogle Scholar
  • 33 Maybody M, Brown KT, Brody LA. , et al. Primary patency of Wallstents in malignant bile duct obstruction: single vs. two or more noncoaxial stents. Cardiovasc Intervent Radiol 2009; 32 (04) 707-713
    CrossrefPubMedGoogle Scholar
  • 34 Brountzos EN, Ptochis N, Panagiotou I, Malagari K, Tzavara C, Kelekis D. A survival analysis of patients with malignant biliary strictures treated by percutaneous metallic stenting. Cardiovasc Intervent Radiol 2007; 30 (01) 66-73
    CrossrefPubMedGoogle Scholar
  • 35 De Palma GD, Galloro G, Siciliano S, Iovino P, Catanzano C. Unilateral versus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction: results of a prospective, randomized, and controlled study. Gastrointest Endosc 2001; 53 (06) 547-553
    CrossrefPubMedGoogle Scholar
  • 36 Hamada T, Isayama H, Nakai Y. , et al. Duodenal invasion is a risk factor for the early dysfunction of biliary metal stents in unresectable pancreatic cancer. Gastrointest Endosc 2011; 74 (03) 548-555
    CrossrefPubMedGoogle Scholar
  • 37 Matsuda Y, Shimakura K, Akamatsu T. Factors affecting the patency of stents in malignant biliary obstructive disease: univariate and multivariate analysis. Am J Gastroenterol 1991; 86 (07) 843-849
    PubMedGoogle Scholar
  • 38 van Boeckel PG, Steyerberg EW, Vleggaar FP. , et al. Multicenter study evaluating factors for stent patency in patients with malignant biliary strictures: development of a simple score model. J Gastroenterol 2011; 46 (09) 1104-1110
    CrossrefPubMedGoogle Scholar
  • 39 Loew BJ, Howell DA, Sanders MK. , et al. Comparative performance of uncoated, self-expanding metal biliary stents of different designs in 2 diameters: final results of an international multicenter, randomized, controlled trial. Gastrointest Endosc 2009; 70 (03) 445-453
    CrossrefPubMedGoogle Scholar
  • 40 Dumonceau JM, Devière J. Self-expandable metal stents. Best Pract Res Clin Gastroenterol 1999; 13 (01) 109-130
    CrossrefPubMedGoogle Scholar
  • 41 Davids PH, Groen AK, Rauws EA, Tytgat GN, Huibregtse K. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet 1992; 340 (8834-8835): 1488-1492
    CrossrefPubMedGoogle Scholar
  • 42 Saleem A, Leggett CL, Murad MH, Baron TH. Meta-analysis of randomized trials comparing the patency of covered and uncovered self-expandable metal stents for palliation of distal malignant bile duct obstruction. Gastrointest Endosc 2011; 74 (02) 321-327.e1 , 3
    CrossrefPubMedGoogle Scholar
  • 43 Willingham FF. All wrapped up: metal biliary stents and the effect of stent coverings. Gastrointest Endosc 2010; 72 (05) 924-926
    CrossrefPubMedGoogle Scholar
  • 44 Lorenz JM. Management of malignant biliary obstruction. Semin Intervent Radiol 2016; 33 (04) 259-267
    Article in Thieme ConnectPubMedGoogle Scholar
  • 45 Isayama H, Komatsu Y, Tsujino T. , et al. A prospective randomised study of “covered” versus “uncovered” diamond stents for the management of distal malignant biliary obstruction. Gut 2004; 53 (05) 729-734
    CrossrefPubMedGoogle Scholar
  • 46 Kullman E, Frozanpor F, Söderlund C. , et al. Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study. Gastrointest Endosc 2010; 72 (05) 915-923
    CrossrefPubMedGoogle Scholar
  • 47 Hyun H, Choi SY, Kim KA, Ko SB. Safety and efficacy of percutaneous biliary covered stent placement in patients with malignant biliary hilar obstruction; correlation with liver function. Cardiovasc Intervent Radiol 2016; 39 (09) 1298-1305
    CrossrefPubMedGoogle Scholar
  • 48 Suk KT, Kim JW, Kim HS. , et al. Human application of a metallic stent covered with a paclitaxel-incorporated membrane for malignant biliary obstruction: multicenter pilot study. Gastrointest Endosc 2007; 66 (04) 798-803
    CrossrefPubMedGoogle Scholar
  • 49 Jang SI, Kim JH, You JW. , et al. Efficacy of a metallic stent covered with a paclitaxel-incorporated membrane versus a covered metal stent for malignant biliary obstruction: a prospective comparative study. Dig Dis Sci 2013; 58 (03) 865-871
    CrossrefPubMedGoogle Scholar
  • 50 Song TJ, Lee SS, Yun SC. , et al. Paclitaxel-eluting covered metal stents versus covered metal stents for distal malignant biliary obstruction: a prospective comparative pilot study. Gastrointest Endosc 2011; 73 (04) 727-733
    CrossrefPubMedGoogle Scholar
  • 51 Mizandari M, Pai M, Xi F. , et al. Percutaneous intraductal radiofrequency ablation is a safe treatment for malignant biliary obstruction: feasibility and early results. Cardiovasc Intervent Radiol 2013; 36 (03) 814-819
    CrossrefPubMedGoogle Scholar
  • 52 Pai M, Valek V, Tomas A. , et al. Percutaneous intraductal radiofrequency ablation for clearance of occluded metal stent in malignant biliary obstruction: feasibility and early results. Cardiovasc Intervent Radiol 2014; 37 (01) 235-240
    CrossrefPubMedGoogle Scholar
  • 53 Aggarwal R, Patel FD, Kapoor R, Kang M, Kumar P, Chander Sharma S. Evaluation of high-dose-rate intraluminal brachytherapy by percutaneous transhepatic biliary drainage in the palliative management of malignant biliary obstruction--a pilot study. Brachytherapy 2013; 12 (02) 162-170
    CrossrefPubMedGoogle Scholar
  • 54 Chen Y, Wang X-L, Yan Z-P. , et al. The use of 125I seed strands for intraluminal brachytherapy of malignant obstructive jaundice. Cancer Biother Radiopharm 2012; 27 (05) 317-323
    CrossrefPubMedGoogle Scholar
  • 55 Zhu HD, Guo JH, Zhu GY. , et al. A novel biliary stent loaded with (125)I seeds in patients with malignant biliary obstruction: preliminary results versus a conventional biliary stent. J Hepatol 2012; 56 (05) 1104-1111
    CrossrefPubMedGoogle Scholar