Endoscopy 2004; 36(4): 334-336
DOI: 10.1055/s-2004-814307
Case Report
© Georg Thieme Verlag Stuttgart · New York

Ultrasonography-Guided Endoscopic Stent Placement for Malignant Biliary Obstruction: A Preliminary Report of Four Cases

G.  D.  De Palma1 , A.  Puzziello1 , M.  Rega1 , L.  Mastantuono1 , F.  Persico1 , F.  Patrone1 , G.  Persico1
  • 1Department of Surgery and Advanced Technologies, Section of Diagnostic and Therapeutic Endoscopy, University Federico II, School of Medicine, Naples, Italy
Further Information

Publication History

Submitted 3 December 2002

Accepted after revision 5 August 2003

Publication Date:
01 April 2004 (online)

We present a new combination of transabdominal ultrasound (US) and biliary endoscopy, with endoscopic stent placement carried out under US guidance. Four patients (two men, two women; average age 66.2 years) underwent US-guided stent placement for palliation of ampullary carcinoma (n = 3) or pancreatic cancer (n = 1). A guide wire and a guiding catheter were endoscopically introduced and identified, by US in the common bile duct across the stricture. Hydromer-coated polyurethane angled stents (10 Fr) were finally inserted over the guide wire/guiding catheter by a pusher tube system. Successful drainage, with substantial reduction in bilirubin level, was achieved in all patients (14.2 ± 9.5 vs. 4.2 ± 2.9 mg/dl at 1 week). The present case series shows that endoscopic stent placement performed under US guidance is safe and effective. Further studies of larger series, including more proximal strictures, are warranted.

References

  • 1 Ballinger A B, McHugh M, Catnach S M. et al . Symptom relief and quality of life after stenting for malignant bile duct obstruction.  Gut. 1994;  35 467-470
  • 2 Cotton P B, Schmitt C. Quality of life in palliative management of malignant obstructive jaundice.  Scand J Gastroenterol. 1993;  199 44-46
  • 3 Shah S k, Mutignani M, Costamagna G. Therapeutic biliary endoscopy. State-of-the-art review.  Endoscopy. 2002;  34 43-53
  • 4 Sutton D (ed). A textbook of radiology and imaging. 6th edn. New York; Churchill Livingstone 1998
  • 5 Muller M F, Mayenberger C, Bertschinger P. et al . Pancreatic tumors: evaluation with endoscopic US, CT and MR imaging.  Radiology. 1994;  190 745-751
  • 6 O’Connor K W, Snodgrass P J, Swonder J E. et al . A blinded prospective study comparing four current non-invasive approaches in the differential diagnosis of medical versus surgical jaundice.  Gastroenterology. 1983;  84 1498-1504
  • 7 Cotton P B, Lehman G, Vennes J. et al . Endoscopic sphincterotomy complications and their management: an attempt at consensus.  Gastrointest Endosc. 1991;  37 383-393
  • 8 Misra S P, Agarwal S K, Gupta A. Endoscopic sphincterotomy, nasobiliary drainage and biliary stent placement without image intensification.  Br J Surg. 1992;  79 1179-1180
  • 9 Siegel J H, Rodriguez R, Cohen S A. et al . Endoscopic management of cholangitis: critical review of an alternative technique and report of a large series.  Am J Gatroenterol. 1994;  89 1142-1146
  • 10 Chawla Y K, Sharma B C, Singh R. et al . Emergency endoscopic nasobiliary drainage without the aid of fluoroscopy.  Indian J Gastroenterol. 1993;  12 97-98
  • 11 Wang H P, Huang S P, Sun M S. et al . Urgent endoscopic nasobiliary drainage without fluoroscopic guidance: A useful treatment for critically ill patients with biliary obstruction.  Gastrointest Endosc. 2000;  52 741-744
  • 12 Schorn T F, Jahns U, Vollmer C, Gugler R. Ultrasound-guided emergency endoscopic retrograde biliary drainage without radiography.  Endoscopy. 1997;  29 232-233

G. De Palma, M. D.

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Email: gdepalma@arrotino.it