Percutaneous treatment of malignant bile duct strictures in patients treated unsuccessfully with ERCP.

BACKGROUND

The preferred treatment of malignant distal bile duct strictures is endoscopic stent insertion. When this fails, percutaneous drainage is an alternative to surgery. The purpose of this study was to evaluate the success and complication rate of temporary percutaneous treatment.

MATERIAL AND METHODS

20 patients (12 men, 8 women, mean age 62 years) with obstructive jaundice secondary to pancreatic carcinoma (14 patients), metastases of colorectal carcinoma (3 patients) and cholangiocarcinoma (3 patients) underwent percutaneous treatment after 2 unsuccessful attempts of endoscopic cannulation. Puncture of the intrahepatic bile duct system was done under US and direct radiological monitoring using a 22-gauge needle.

RESULTS

In 11 patients bile was drained internally-externally using multiple side holes catheters placed percutaneously via the bile ducts and Vater's papilla into the duodenum. In 4 patients bile was drained internally by percutaneous stent insertion. In all other patients bile was drained externally. The internal-external bile drainage was temporary. 14 days after this procedure in all patients endoscopic sphincterotomy was performed and endoprosthesis was placed. In the group with percutaneous internal bile drainage further endoscopic treatment was successful in 2 patients and in remaining patients the next stent had to be inserted percutaneously. In the group with percutaneous external bile drainage stent placement during ERCP was possible in 2 patients. The overall success rate for bile drainage was 100%. In 15 patients (75%) further endoscopic retrograde procedures were thus made possible. Complications occurred in 2 of the 20 patients (10%). None were life-threatening and surgical intervention was not necessary. One patient developed cholangitis and one another--bacteraemia.

CONCLUSION

Temporary, percutaneous bile drainage is an alternative with a high success rate when endoscopic cannulation fails. Surgery can be avoided in nearly 75% of cases.