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Percutaneous Decompression of Benign and Malignant Biliary Obstruction

Percutaneous Decompression of Benign and Malignant Biliary Obstruction Abstract • Percutaneous transhepatic catheterization of the biliary tree was performed in 41 patients with obstructive jaundice. In 39 patients, the catheter was successfully advanced past the obstructing lesion into the distal common duct and duodenum to establish internal biliary drainage. The remaining two patients had the obstructed biliary tract drained externally. Chronic internal catheter drainage was instituted in five patients with stricture and ten with malignant obstruction as a means of palliating symptomatic jaundice. Twenty-two patients had marked reduction in serum bilirubin levels and pruritis, eight patients had moderate decreases in serum bilirubin levels, and six patients did not improve despite adequate catheterization due to hepatic parenchymal disease. This procedure effectively decompresses the severely obstructed biliary tree prior to surgery and can also palliate patients with unresectable malignant biliary obstruction and stent high-risk, benign strictures. (Arch Surg 114:148-151, 1979) References 1. Okuda K, Tanikawa K, Emura T, et al: Nonsurgical percutaneous transhepatic cholangiography: Diagnostic significance in medical problems of the liver . Am J Dig Dis 19:21-36, 1974.Crossref 2. Redecker A, Karvountgis GG, Richman RH, et al: Percutaneous transhepatic cholangiography: An improved technique . JAMA 231:386-387, 1975.Crossref 3. Molnar W, Stockman AE: Relief of obstructive jaundice through percutaneous transhepatic catheter: A new therapeutic method . Am J Roentgenol 122:356-367, 1974.Crossref 4. Tylen V, Hoevels J, Vang J: Percutaneous transhepatic cholangiography with external drainage of obstructive biliary lesions . Surg Gynecol Obstet 144:13-18, 1977. 5. Mori K, Misumi A, Suguyama M, et al: Percutaneous transhepatic bile drainage . Ann Surg 185:111-115, 1977.Crossref 6. Nakayama T, Ikeda A, Okuda K: Percutaneous transhepatic drainage of the biliary tract . Gastroenterol 74:554-559, 1978. 7. Burcharth F: A new endoprosthesis for nonoperative intubation of the biliary tract in malignant obstructive jaundice . Surg Gynecol Obstet 146:76-78, 1978. 8. Ring EJ, Oleaga JA, Freiman DB, et al: Therapeutic applications of catheter cholangiography. Radiology, to be published. 9. Ferruci JT, Wittenberg J, Sarno RA, et al: Fine needle transhepatic cholangiography: A new approach to obstructive jaundice . Am J Roentgenol 127:403-407, 1976.Crossref 10. Shapiro TM: Adenocarcinoma of the pancreas: A statistical analysis of biliary bypass vs Whipple resection in good risk patients . Ann Surg 182:715-721, 1975.Crossref 11. Crile G Jr: The advantages of bypass operations over radical pancreatoduodenectomy in the treatment of pancreatic carcinoma . Surg Gynecol Obstet 130:1049-1053, 1970. 12. Feduska NJ, Dent TL, Lindenauer SM: Results of palliative operations for carcinoma of the pancreas . Arch Surg 103:330-334, 1971.Crossref 13. Hertzburg J: Pancreatico-duodenal resection and bypass operation in patients with carcinoma of the head of the pancreas, ampulla and distal end of the common duct . Acta Chir Scand 140:523-527, 1974. 14. Buckwalter JA, Lawton RL, Tidrick RT: Bypass operations for neoplastic biliary tract obstruction . Am J Surg 109:100-106, 1965.Crossref 15. Webster JT: Carcinoma of the pancreas and peri-ampullary region: A clinical study in a district general hospital . Br J Surg 62:130-134, 1975.Crossref 16. Gatti DJ, O'Brien PH, Grooms GA: Analysis of pancreatoduodenectomy . South Med J 67:278-286, 1974.Crossref 17. Braasch JW, Gray BN: Considerations that lower pancreatoduodenectomy mortality . Am J Surg 133:480-484, 1977.Crossref 18. Brooks JR, Culebras JM: Cancer of the pancreas: Palliative operation. Whipple procedure or total pancreatectomy . Am J Surg 131:516-520, 1976.Crossref 19. Buranasiri S, Baum S: The significance of the venous phase of celiac and mesenteric arteriography in evaluating pancreatic carcinoma . Radiology 102:11-20, 1972.Crossref 20. Viamonte M, LePage JR, Lunderguist A, et al: Selective catheterization of the portal vein and its tributaries . Radiology 114:457-460, 1975.Crossref 21. Forsgren L, Urell S: Aspiration cytology in carcinoma of the pancreas . Surgery 73:38-42, 1973. 22. Braasch JW, Warren KW, Blevens PK: Progress in biliary stricture repair . Am J Surg 129:34-37, 1975.Crossref 23. Smith R: Hepaticojejunostomy with transhepatic intubation: A technique for very high strictures of the hepatic ducts . Br J Surg 51:186-194, 1964.Crossref 24. Stone RM, Cohen Z, Taylor BR, et al: Bile duct injury: Results of repair using a changeable stent . Am J Surg 125:253-256, 1973.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Percutaneous Decompression of Benign and Malignant Biliary Obstruction

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References (26)

Publisher
American Medical Association
Copyright
Copyright © 1979 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1979.01370260038005
Publisher site
See Article on Publisher Site

Abstract

Abstract • Percutaneous transhepatic catheterization of the biliary tree was performed in 41 patients with obstructive jaundice. In 39 patients, the catheter was successfully advanced past the obstructing lesion into the distal common duct and duodenum to establish internal biliary drainage. The remaining two patients had the obstructed biliary tract drained externally. Chronic internal catheter drainage was instituted in five patients with stricture and ten with malignant obstruction as a means of palliating symptomatic jaundice. Twenty-two patients had marked reduction in serum bilirubin levels and pruritis, eight patients had moderate decreases in serum bilirubin levels, and six patients did not improve despite adequate catheterization due to hepatic parenchymal disease. This procedure effectively decompresses the severely obstructed biliary tree prior to surgery and can also palliate patients with unresectable malignant biliary obstruction and stent high-risk, benign strictures. (Arch Surg 114:148-151, 1979) References 1. Okuda K, Tanikawa K, Emura T, et al: Nonsurgical percutaneous transhepatic cholangiography: Diagnostic significance in medical problems of the liver . Am J Dig Dis 19:21-36, 1974.Crossref 2. Redecker A, Karvountgis GG, Richman RH, et al: Percutaneous transhepatic cholangiography: An improved technique . JAMA 231:386-387, 1975.Crossref 3. Molnar W, Stockman AE: Relief of obstructive jaundice through percutaneous transhepatic catheter: A new therapeutic method . Am J Roentgenol 122:356-367, 1974.Crossref 4. Tylen V, Hoevels J, Vang J: Percutaneous transhepatic cholangiography with external drainage of obstructive biliary lesions . Surg Gynecol Obstet 144:13-18, 1977. 5. Mori K, Misumi A, Suguyama M, et al: Percutaneous transhepatic bile drainage . Ann Surg 185:111-115, 1977.Crossref 6. Nakayama T, Ikeda A, Okuda K: Percutaneous transhepatic drainage of the biliary tract . Gastroenterol 74:554-559, 1978. 7. Burcharth F: A new endoprosthesis for nonoperative intubation of the biliary tract in malignant obstructive jaundice . Surg Gynecol Obstet 146:76-78, 1978. 8. Ring EJ, Oleaga JA, Freiman DB, et al: Therapeutic applications of catheter cholangiography. Radiology, to be published. 9. Ferruci JT, Wittenberg J, Sarno RA, et al: Fine needle transhepatic cholangiography: A new approach to obstructive jaundice . Am J Roentgenol 127:403-407, 1976.Crossref 10. Shapiro TM: Adenocarcinoma of the pancreas: A statistical analysis of biliary bypass vs Whipple resection in good risk patients . Ann Surg 182:715-721, 1975.Crossref 11. Crile G Jr: The advantages of bypass operations over radical pancreatoduodenectomy in the treatment of pancreatic carcinoma . Surg Gynecol Obstet 130:1049-1053, 1970. 12. Feduska NJ, Dent TL, Lindenauer SM: Results of palliative operations for carcinoma of the pancreas . Arch Surg 103:330-334, 1971.Crossref 13. Hertzburg J: Pancreatico-duodenal resection and bypass operation in patients with carcinoma of the head of the pancreas, ampulla and distal end of the common duct . Acta Chir Scand 140:523-527, 1974. 14. Buckwalter JA, Lawton RL, Tidrick RT: Bypass operations for neoplastic biliary tract obstruction . Am J Surg 109:100-106, 1965.Crossref 15. Webster JT: Carcinoma of the pancreas and peri-ampullary region: A clinical study in a district general hospital . Br J Surg 62:130-134, 1975.Crossref 16. Gatti DJ, O'Brien PH, Grooms GA: Analysis of pancreatoduodenectomy . South Med J 67:278-286, 1974.Crossref 17. Braasch JW, Gray BN: Considerations that lower pancreatoduodenectomy mortality . Am J Surg 133:480-484, 1977.Crossref 18. Brooks JR, Culebras JM: Cancer of the pancreas: Palliative operation. Whipple procedure or total pancreatectomy . Am J Surg 131:516-520, 1976.Crossref 19. Buranasiri S, Baum S: The significance of the venous phase of celiac and mesenteric arteriography in evaluating pancreatic carcinoma . Radiology 102:11-20, 1972.Crossref 20. Viamonte M, LePage JR, Lunderguist A, et al: Selective catheterization of the portal vein and its tributaries . Radiology 114:457-460, 1975.Crossref 21. Forsgren L, Urell S: Aspiration cytology in carcinoma of the pancreas . Surgery 73:38-42, 1973. 22. Braasch JW, Warren KW, Blevens PK: Progress in biliary stricture repair . Am J Surg 129:34-37, 1975.Crossref 23. Smith R: Hepaticojejunostomy with transhepatic intubation: A technique for very high strictures of the hepatic ducts . Br J Surg 51:186-194, 1964.Crossref 24. Stone RM, Cohen Z, Taylor BR, et al: Bile duct injury: Results of repair using a changeable stent . Am J Surg 125:253-256, 1973.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Feb 1, 1979

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