PDF herunterladen
Semin intervent Radiol 2021; 38(03): 300-308
DOI: 10.1055/s-0041-1731269
Review Article

Treatment of Malignant Bile Duct Obstruction: What the Interventional Radiologist Needs to Know

Juan C. Camacho
1   Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, Weill-Cornell Medical Center, New York, New York
,
Lynn A. Brody
1   Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, Weill-Cornell Medical Center, New York, New York
,
Anne M. Covey
1   Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, Weill-Cornell Medical Center, New York, New York
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Management of malignant bile duct obstruction is both a clinically important and technically challenging aspect of caring for patients with advanced malignancy. Bile duct obstruction can be caused by extrinsic compression, intrinsic tumor/stone/debris, or by biliary ischemia, inflammation, and sclerosis. Common indications for biliary intervention include lowering the serum bilirubin level for chemotherapy, ameliorating pruritus, treating cholangitis or bile leak, and providing access for bile duct biopsy or other adjuvant therapies. In some institutions, biliary drainage may also be considered prior to hepatic or pancreatic resection. Prior to undertaking biliary intervention, it is essential to have high-quality cross-sectional imaging to determine the level of obstruction, the presence of filling defects or atrophy, and status of the portal vein. High bile duct obstruction, which we consider to be obstruction above, at, or just below the confluence (Bismuth classifications IV, III, II, and some I), is optimally managed percutaneously rather than endoscopically because interventional radiologists can target specific ducts for drainage and can typically avoid introducing enteric contents into isolated undrained bile ducts. Options for biliary drainage include external or internal/external catheters and stents. In the setting of high obstruction, placement of a catheter or stent above the ampulla, preserving the function of the sphincter of Oddi, may lower the risk of future cholangitis by preventing enteric contamination of the biliary tree. Placement of a primary suprapapillary stent without a catheter, when possible, is the procedure most likely to keep the biliary tree sterile.

Keywords

malignant biliary obstruction - endoscopic stenting - biliary strictures - common bile duct


Publikationsverlauf

Artikel online veröffentlicht:
10. August 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Leng JJ, Zhang N, Dong JH. Percutaneous transhepatic and endoscopic biliary drainage for malignant biliary tract obstruction: a meta-analysis. World J Surg Oncol 2014; 12 (01) 272
    CrossrefPubMedGoogle Scholar
  • 2 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
  • 3 Maseda E, Maggi G, Gomez-Gil R. et al. Prevalence of and risk factors for biliary carriage of bacteria showing worrisome and unexpected resistance traits. J Clin Microbiol 2013; 51 (02) 518-521
    CrossrefPubMedGoogle Scholar
  • 4 Razumilava N, Gores GJ. Cholangiocarcinoma. Lancet 2014; 383 (9935): 2168-2179
    CrossrefPubMedGoogle Scholar
  • 5 Tsukahara T, Shimoyama Y, Ebata T. et al. Cholangiocarcinoma with intraductal tubular growth pattern versus intraductal papillary growth pattern. Mod Pathol 2016; 29 (03) 293-301
    CrossrefPubMedGoogle Scholar
  • 6 Gonzalez-Aguirre A, Covey AM, Brown KT. et al. Comparison of biliary brush biopsy and fine needle biopsy in the diagnosis of biliary strictures. Minim Invasive Ther Allied Technol 2018; 27 (05) 278-283
    CrossrefPubMedGoogle Scholar
  • 7 Augustin AM, Steingrüber M, Fluck F, Goetze O, Bley TA, Kickuth R. Percutaneous endobiliary forceps biopsy of biliary strictures for histopathologic examination. Diagn Interv Radiol 2020; 26 (04) 339-344
    CrossrefPubMedGoogle Scholar
  • 8 Monier A, Guiu B, Duran R. et al. Liver and biliary damages following transarterial chemoembolization of hepatocellular carcinoma: comparison between drug-eluting beads and lipiodol emulsion. Eur Radiol 2017; 27 (04) 1431-1439
    CrossrefPubMedGoogle Scholar
  • 9 Guiu B, Deschamps F, Aho S. et al. Liver/biliary injuries following chemoembolisation of endocrine tumours and hepatocellular carcinoma: lipiodol vs. drug-eluting beads. J Hepatol 2012; 56 (03) 609-617
    CrossrefPubMedGoogle Scholar
  • 10 Zhang L, Sun JH, Ji JS. et al. Imaging changes and clinical complications after drug-eluting beads versus conventional transarterial chemoembolization for unresectable hepatocellular carcinoma: multicenter study. AJR Am J Roentgenol 2020
    PubMedGoogle Scholar
  • 11 Bismuth H. Postoperative strictures of the bile duct. In: Blumgart LH. ed. The Biliary Tract. Clinical Surgery International, Vol 5. Edinburgh: Churchill Livingstone; 1982: 209-218
    Google Scholar
  • 12 Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg 1992; 215 (01) 31-38
    CrossrefPubMedGoogle Scholar
  • 13 Joerger M, Huitema AD, Koeberle D. et al. Safety and pharmacology of gemcitabine and capecitabine in patients with advanced pancreatico-biliary cancer and hepatic dysfunction. Cancer Chemother Pharmacol 2014; 73 (01) 113-124
    CrossrefPubMedGoogle Scholar
  • 14 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
  • 15 Kremer AE, Bolier R, van Dijk R, Oude Elferink RP, Beuers U. Advances in pathogenesis and management of pruritus in cholestasis. Dig Dis 2014; 32 (05) 637-645
    CrossrefPubMedGoogle Scholar
  • 16 Bassari R, Koea JB. Jaundice associated pruritis: a review of pathophysiology and treatment. World J Gastroenterol 2015; 21 (05) 1404-1413
    CrossrefPubMedGoogle Scholar
  • 17 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
  • 18 Wiggers JK, Groot Koerkamp B, Coelen RJ. et al. Percutaneous preoperative biliary drainage for resectable perihilar cholangiocarcinoma: no association with survival and no increase in seeding metastases. Ann Surg Oncol 2015; 22 (Suppl. 03) S1156-S1163
    CrossrefPubMedGoogle Scholar
  • 19 Mavilia MG, Molina M, Wu GY. The evolving nature of hepatic abscess: a review. J Clin Transl Hepatol 2016; 4 (02) 158-168
    PubMedGoogle Scholar
  • 20 Lardière-Deguelte S, Ragot E, Amroun K. et al. Hepatic abscess: diagnosis and management. J Visc Surg 2015; 152 (04) 231-243
    CrossrefPubMedGoogle Scholar
  • 21 Li S, Li B, Li L, Yang X, Xu F, Wang W. The efficacy of the combination of percutaneous transhepatic biliary drainage and 125I stranded seeds for malignant bile duct obstruction treatment. J Contemp Brachytherapy 2020; 12 (03) 225-232
    CrossrefPubMedGoogle Scholar
  • 22 Ahmed S, Schlachter TR, Hong K. Percutaneous transhepatic cholangioscopy. Tech Vasc Interv Radiol 2015; 18 (04) 201-209
    CrossrefPubMedGoogle Scholar
  • 23 Fang Y, Gurusamy KS, Wang Q. et al. Pre-operative biliary drainage for obstructive jaundice. Cochrane Database Syst Rev 2012; 9 (09) CD005444
    PubMedGoogle Scholar
  • 24 Shaib Y, Rahal MA, Rammal MO, Mailhac A, Tamim H. Preoperative biliary drainage for malignant biliary obstruction: results from a national database. J Hepatobiliary Pancreat Sci 2017; 24 (11) 637-642
    CrossrefPubMedGoogle Scholar
  • 25 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
  • 26 Wang L, Lin N, Xin F, Ke Q, Zeng Y, Liu J. A systematic review of the comparison of the incidence of seeding metastasis between endoscopic biliary drainage and percutaneous transhepatic biliary drainage for resectable malignant biliary obstruction. World J Surg Oncol 2019; 17 (01) 116
    CrossrefPubMedGoogle Scholar
  • 27 Rerknimitr R, Angsuwatcharakon P, Ratanachu-ek T. et al; Asia-Pacific Working Group on Hepatobiliary Cancers. Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma. J Gastroenterol Hepatol 2013; 28 (04) 593-607
    CrossrefPubMedGoogle Scholar
  • 28 Liu JG, Wu J, Wang J. et al. Endoscopic biliary drainage versus percutaneous transhepatic biliary drainage in patients with resectable hilar cholangiocarcinoma: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A 2018; 28 (09) 1053-1060
    CrossrefPubMedGoogle Scholar
  • 29 Al Mahjoub A, Menahem B, Fohlen A. et al. Preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma: is percutaneous transhepatic biliary drainage safer and more effective than endoscopic biliary drainage? A meta-analysis. J Vasc Interv Radiol 2017; 28 (04) 576-582
    CrossrefPubMedGoogle Scholar
  • 30 Dhondt E, Vanlangenhove P, Geboes K, Vandenabeele L, Van Cauwenberghe L, Defreyne L. No evidence of improved efficacy of covered stents over uncovered stents in percutaneous palliation of malignant hilar biliary obstruction: results of a prospective randomized trial. Eur Radiol 2020; 30 (01) 175-185
    CrossrefPubMedGoogle Scholar
  • 31 Dhondt E, Vanlangenhove P, De Man M, Huyck L, Defreyne L. No advantage of expanded polytetrafluoroethylene and fluorinated ethylene propylene-covered stents over uncovered nitinol stents for percutaneous palliation of malignant infrahilar biliary obstruction: results of a single-center prospective randomized trial. J Vasc Interv Radiol 2020; 31 (01) 82-92
    CrossrefPubMedGoogle Scholar
  • 32 Shin J, Park JS, Jeong S, Lee DH. Comparison of the clinical outcomes of suprapapillary and transpapillary stent insertion in unresectable cholangiocarcinoma with biliary obstruction. Dig Dis Sci 2020; 65 (04) 1231-1238
    CrossrefPubMedGoogle Scholar
  • 33 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
  • 34 Li TF, Li Z, Han XW. et al. Combined T/Y biliary stent placement for the treatment of biliary obstruction caused by Bismuth-Corlett type IV hilar cholangiocarcinoma. Hepatogastroenterology 2014; 61 (134) 1519-1522
    PubMedGoogle Scholar
  • 35 Kwon JH, Gwon DI, Kim JW. et al. Percutaneous biliary metallic stent insertion in patients with malignant duodenobiliary obstruction: outcomes and factors influencing biliary stent patency. Korean J Radiol 2020; 21 (06) 695-706
    CrossrefPubMedGoogle Scholar
  • 36 Guimaraes M, Uflacker A, Schönholz C, Uflacker R. Successful recanalization of bile duct occlusion with a radiofrequency puncture wire technique. J Vasc Interv Radiol 2010; 21 (02) 289-294
    CrossrefPubMedGoogle Scholar
  • 37 Ahmed O, Mathevosian S, Arslan B. Biliary interventions: tools and techniques of the trade, access, cholangiography, biopsy, cholangioscopy, cholangioplasty, stenting, stone extraction, and brachytherapy. Semin Intervent Radiol 2016; 33 (04) 283-290
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 38 Morita S, Takemura T, Matsumoto S, Odani R. Septic shock after percutaneous transhepatic drainage of obstructed afferent loop: case report. Cardiovasc Intervent Radiol 1989; 12 (02) 66-68
    CrossrefPubMedGoogle Scholar
  • 39 Laleman W, van der Merwe S, Verbeke L. et al. A new intraductal radiofrequency ablation device for inoperable biliopancreatic tumors complicated by obstructive jaundice: the IGNITE-1 study. Endoscopy 2017; 49 (10) 977-982
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 40 Alis H, Sengoz C, Gonenc M, Kalayci MU, Kocatas A. Endobiliary radiofrequency ablation for malignant biliary obstruction. Hepatobiliary Pancreat Dis Int 2013; 12 (04) 423-427
    CrossrefPubMedGoogle Scholar
  • 41 Dolak W, Schreiber F, Schwaighofer H. et al; Austrian Biliary RFA Study Group. Endoscopic radiofrequency ablation for malignant biliary obstruction: a nationwide retrospective study of 84 consecutive applications. Surg Endosc 2014; 28 (03) 854-860
    CrossrefPubMedGoogle Scholar
  • 42 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