Percutaneous transhepatic insertion of a permanent endoprosthesis in obstructive lesions of the extrahepatic bile ducts.

A Teflon endoprosthesis for permanent bile drainage was inserted in 13 patients following percutaneous transhepatic puncture and catheterization of the bile duct system. Twelve patients had extrahepatic cholestasis because of a malignant tumor, whereas one patient had chronic inflammation involving the hepatoduodenal ligament (secondary to Crohn's disease) with obstruction of the extrahepatic bile ducts. The drainage periods varied from 1 week to 8 months. The endoprosthesis was regarded as partially effective in seven patients whereas in six cases the drainage through the endoprosthesis was insufficient and external bile drainage through a percutaneous transhepatic catheter was necessary. Infection of the bile duct system during the drainage period with a percutaneous transhepatic catheter and/or bile duct endoprosthesis occurred in 10 patients. Spontaneous dislocation of the endoprosthesis occurred in varying degrees in five patients. One patient developed an intrahepatic aneurysm adjacent to the puncture tract and died because of liver insufficiency following therapeutic embolization of the aneurysm and most of the hepatic arteries by injection of gelfoam particles into the common hepatic artery. Patients in whom palliative treatment by insertion of a permanent bile duct endoprosthesis may be suitable were defined.