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DOI: 10.1055/s-0039-1681626
ENDOSCOPIC PALLIATION OF HILAR COLANGIOCARCINOMA – USEFULNESS OF SELECTIVE OCCLUSION OF ONE INTRAHEPATIC DUCT
Publication History
Publication Date:
18 March 2019 (online)
Description:
ERCP with stent placement for palliative biliary drainage is a common strategy used in the management of patients with unresectable hilar cholangiocarcinomas (HC).
Selective placement of two guidewires, one in the right intrahepatic duct (RIHD) and the other in the left hepatic duct (LIHD) is an essential pre-requisite for bilateral stenting. However, the insertion of the second guidewire to the contralateral intrahepatic duct can be extremely difficult in some patients, even after using multiple maneuvers, using different types of catheters and guidewires.
In this video, we demonstrate a technique to overcome the inability to direct the second guidewire to the contralateral intrahepatic duct. We describe an 85-year old man, with a type II HC, referred to our department for palliative bilateral stenting. After swiftly passing the first guidewire to the right lobe, we faced unexpected difficulties in directing the second guidewire to the dilated LIHD. Several maneuvers were attempted, including the use of angled-tip and small caliber hydrophilic wires, but all resulted invariably in cannulation of the right system. In order to overcome this difficulty, we introduced a 15-mm retrieval balloon into the dilated RHD; the balloon was inflated immediately proximal to the hepatic bifurcation, blocking the access to the RIHD. Subsequently, a second guidewire was inserted alongside the balloon catheter, across the hilar stricture and easily deflected off the inflated balloon into the LIHD. Two self-expandable metal stents were successfully deployed.
Motivation:
To the best of our knowledge there are no multimedia reports on this technical tip to facilitate the passage of a second guidewire to the opposite intrahepatic duct, which was first reported by Husain et al. Use of this technical maneuver could be a very useful tool for increasing the success of bilateral stenting in patients with hilar cholangiocarcinoma.
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