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percutaneous Biliary Interventions: Clinical Indications, Comparative Effectiveness, Technical Considerations, Complications, and Outcomes

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Gastrointestinal Endoscopy Clinics of North America 2022年第3期32卷 493-505页

作者： Hafezi-Nejad, Nima Liddell, Robert P. Division of Vascular and Interventional Radiology Department of Radiology and Radiological Sciences Johns Hopkins School of Medicine 1800 Orleans Street Sheik Zayed Tower Suite 7203 Baltimore 21287 MD United States

percutaneous biliary interventions (PBIs) are commonly performed by interventional radiologists for a variety of clinical indications including biliary infections, strictures, leaks, and postoperative complications. PBIs have high technical and clinical success rates and are relatively safe when compared with more invasive surgical techniques. percutaneous transhepatic cholangiography and percutaneous biliary drainage play an essential role in the management of common posthepatobiliary complications including biliary strictures and leaks. percutaneous biliary endoscopy can be used for direct visualization of the biliary tree and a variety of interventions including tissue biopsy, lithotripsy, stone removal, as well as stent placement and removal.

关键词： External biliary drain percutaneous biliary endoscopy percutaneous biliary interventions percutaneous transhepatic cholangiogram

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Cholangioscopy-assisted rendezvous endoscopic retrograde cholangiography technique for a difficult postliver transplant anastomotic stricture

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VideoGIE 2025年

作者： Singh, Pankaj Singla, Vikas Goel, Akash Shawl, Muzaffar Rashid Bashir, Shahnawaz Institute of Gastroenterology Hepatology and Endoscopy Max Superspeciality Hospital New Delhi India

Background and Aims: In cases of postliver transplant biliary stricture with double duct anastomsis, double-duct stenting is absolutely necessary to preserve graft function. Methods: We present a successful technique of percutaneous cholangioscopy-assisted rendezvous ERC for difficult anastomotic stricture after failure of cholangioscopy-guided wire negotiation and percutaneous transhepatic biliary drainage. Results: We achieved successful completion of biliary drainage through right anterior sectoral duct and right posterior duct stenting with subsequent dilatation of stricture. There was resolution of anastomotic stricture on follow-up. Conclusions: Cholangioscopy-assisted rendezvous endoscopic retrograde cholangiography technique is a reasonable option for difficult posttransplant anastomotic stricture when conventional methods fail. © 2025 American Society for Gastrointestinal Endoscopy

关键词： PTBD percutaneous transhepatic biliary drainage RPSD Right Posterior sectoral Duct RASD Right Anterior sectoral Duct PTC percutaneous transhepatic cholangiogram IHD Intrahepatic Ducts F French

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Utilization of a Modified Roux-en-Y Anastomosis as an Access point for percutaneous Transjejunal Cholangioplasty of Recurrent Biliary Strictures

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CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY 2019年第12期42卷 1745-1750页

作者： Sandhu, Jagteshwar Swersky, Adam Salsamendi, Jason Abrahams, Robert B. Venkat, Shree Sleeman, Danny Mohan, Prasoon Univ Miami Miller Sch Med 1600 NW 10th Ave 1140 Miami FL 33136 USA Univ Miami Jackson Mem Hosp Miller Sch Med Dept Intervent Radiol Miami FL 33136 USA Haywood Med Imaging Diagnost & Intervent Radiologist Clyde NC USA Univ Miami Jackson Mem Hosp Miller Sch Med Dept Surg Miami FL 33136 USA

Introduction Biliary duct injuries pose a significant management challenge due to the propensity for recurrent biliary strictures. Development of a modified Roux-en-Y hepaticojejunostomy known as a Hutson-Russell Pouch (HRP) provides a point of entry for repetitive access to the biliary tree. We aim to highlight the effectiveness of using the HRP as an access point for the long-term management of anastomotic and distal biliary strictures, thereby showcasing the value in potential widespread adoption of this modification to a standard surgical procedure. Materials and methods IRB-approved retrospective study of 36 patients (10 M, 26 F;mean age 55.19 +/- 13.94;15-83) underwent a total of 110 transjejunal cholangiograms. Indications for cholangiogram included cholangitis (n = 38), surveillance (n = 36), and elevated liver enzymes (n = 36). Technical success was defined by the ability to access and intervene in the biliary tree via HRP access. In case of stenosis, the ability to successfully dilate (< 30%) residual stenosis was considered a technically successful procedure. Clinical success was defined by normalization of the liver function tests or resolution of cholangitis. Results Technical success was achieved in 83/110 (75.45%) of the cases, and clinical success was achieved in 102/110 (98.2%). transhepatic access was needed in 27/110 (24.5%) of the cases. Interventions performed included balloon cholangioplasty in 104/110 (94.5%), biliary stone removal in 2/110 (1.8%), biliary stent placement in 2/110 (1.8%), and biliary drain placement in 4/110 (3.6%). There were a total of 9/110 complications (8.2%). Conclusion The HRP was an effective access point in the management of recurrent benign biliary strictures in this cohort.

关键词： Hutson-russell pouch Modified Roux-en-Y hepaticojejunostomy Transjejunal cholangiogram Cholangioplasty percutaneous transhepatic cholangiogram Benign biliary strictures

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Treating Biliary-Enteric Anastomotic Strictures with Enteroscopy-ERCP Requires Fewer Procedures than percutaneous transhepatic Biliary Drains

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DIGESTIVE DISEASES AND SCIENCES 2019年第9期64卷 2638-2644页

作者： Hammad, Hazem Brauer, Brian C. Smolkin, Maximiliano Ryu, Robert Obuch, Joshua Shah, Raj J. Univ Colorado Div Gastroenterol & Hepatol Anschutz Med Campus Aurora CO 80045 USA Univ Colorado Dept Med Anschutz Med Campus Aurora CO USA Geisinger Wyoming Valley Med Ctr Div Gastroenterol Wilkes Barre PA USA Univ Colorado Dept Radiol Anschutz Med Campus Aurora CO USA

Background Biliary-enteric anastomotic strictures (AS) in long-limb surgical biliary bypass (LLBB) require percutaneous transhepatic biliary drains (PTBD), enteroscopy-assisted ERCP (E-ERCP), or surgical revision. Aim To compare E-ERCP and PTBD for AS treatment. Methods E-ERCP stricturoplasty included dilation, cautery, and stent;PTBD included balloon dilation and serial drain upsizing events. Results From May 2008 to October 2015, 71 patients (37 M, median age 52) had E-ERCP (n = 45) or PTBD (n = 26) for AS in Roux-en-Y hepaticojejunostomy: liver transplant (n = 28), cholecystectomy injury revision (n = 21), other (n = 13) or Whipple's resection (n = 9). Median follow-up is 11 months (range 1-56) in 67 (94%) patients. Technical success, clinical improvement, and adverse events between E-ERCP and PTBD were similar (76% vs. 77%, p = 0.89;82% vs. 85%, p = 0.80, and 6% vs. 5%, p = 0.60, respectively). However, E-ERCP had fewer post-procedural hospitalization days (0.2 +/- 0.65 vs. 4.5 +/- 10, p = 0.0001), mean procedures (4.4 +/- 6.3 vs. 9.5 +/- 8, p = 0.006), and median months of treatment to resolve AS (1, range 1-22 vs. 7, range 3-23;p = 0.003). Two patients in PTBD group required surgery. Conclusions (1) Technical success and clinical improvement are seen in the majority of LLBB patients with biliary-enteric AS undergoing E-ERCP or PTBD. (2) E-ERCP is associated with fewer procedures, post-procedure hospitalization days, and months to resolve AS. When expertise is available, E-ERCP to identify and treat AS should be considered as an alternative to PTBD.

关键词： Roux-en-Y hepaticojejunostomy ERCP Enteroscopy Anastomotic stricture percutaneous transhepatic cholangiogram PTC

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The Utility of a Benign Biliary Stricture Protocol in Preventing Symptomatic Recurrence and Surgical Revision

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JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY 2018年第5期29卷 688-694页

作者： Kirkpatrick, Daniel L. Hasham, Hasnain Collins, Zachary Johnson, Philip Lemons, Steven Shahzada, Hassan Hunt, Suzanne L. Walter, Carissa Hill, Jacqueline Fahrbach, Thomas Univ Kansas Med Ctr Dept Radiol 3901 Rainbow Blvd Kansas City KS 66160 USA

Purpose: To determine whether treating benign biliary strictures via a stricture protocol reduced the probability of developing symptomatic recurrence and requiring surgical revision compared to nonprotocol treatment. Materials and Methods: A stricture protocol was designed to include serial upsizing of internal/external biliary drainage catheters to a target maximum dilation of 18-French, optional cholangioplasty at each upsizing, and maintenance of the largest catheter for at least 6 months. Patients were included in this retrospective analysis if they underwent biliary ductal dilation at a single institution from 2005 to 2016. Forty-two patients were included, 25 women and 17 men, with an average age of 51.9 years (standard deviation +/- 14.6). Logistic regression models were used to determine the probability of symptomatic recurrence and surgical revision by stricture treatment type. Results: Twenty-two patients received nonprotocol treatment, while 20 received treatment on a stricture protocol. After treatment, 7 (32%) patients in the nonprotocol group experienced clinical or laboratory recurrence of a benign stricture, whereas only 1 patient in the stricture protocol group experienced symptom recurrence. Patients in the protocol group were 8.9 times (95% confidence interval [CI] = 1.4-175.3) more likely to remain symptom free than patients in the nonprotocol group. Moreover, patients in the protocol group had an estimated 89% reduction in the probability of undergoing surgical revision compared to patients receiving nonprotocol treatment (odds ratio = .11, 95% CI = .01-.73). Conclusions: Establishing a stricture protocol may decrease the risk of stricture recurrence and the need for surgical revision when compared to a nonprotocol treatment approach.

关键词： OLT orthotopic liver transplant PSC primary sclerosing cholangitis PTC percutaneous transhepatic cholangiogram

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Evaluation of a three-session biliary dilation protocol following transplant-related biliary stricture in pediatric patients

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PEDIATRIC TRANSPLANTATION 2019年第7期23卷 e13551-e13551页

作者： Reis, Stephen P. Bruestle, Karina Brejt, Sidney Tulin-Silver, Sheryl Frenkel, Joseph Mobley, David G. England, Ryan W. Sobolevsky, Sergei Griesemer, Adam D. Sperling, David Schlossberg, Peter Susman, Jonathan Weintraub, Joshua L. Columbia Univ Irving Med Ctr Div Intervent Radiol 630 West 168th StMC 28 New York NY 10032 USA Morgan Stanley Childrens Hosp New York New York NY USA Columbia Univ Dept Surg Div Transplant Surg Irving Med Ctr New York NY 10032 USA Columbia Univ Coll Phys & Surg Columbia Ctr Translat Immunol New York NY 10032 USA Albert Einstein Univ Coll Med New York NY USA Columbia Univ Coll Phys & Surg New York NY 10032 USA

To evaluate whether a serial biliary dilation protocol improves outcomes and decreases total biliary drainage time for biliary strictures following pediatric liver transplantation. From 2006 to 2016, 213 orthotopic deceased and living related liver transplants were performed in 199 patients with a median patient age of 3.1 years at a single pediatric hospital. Patients with biliary strictures were managed by IR or surgically by the transplant team. Patients managed by IR were divided into two groups. The first group was managed with a standardized three-session protocol consisting of dilation every two weeks for three dilations. The second group was managed clinically with varying number and interval of dilations as determined by a multidisciplinary team. The location of biliary stricture, duration of drainage, number of balloon dilations, balloon diameter, time interval between dilations, and success of percutaneous treatment were recorded. Thirty-four patients developed biliary strictures. Thirty-one patients were managed with percutaneous intervention. Three strictures could not be crossed and were converted to operative management. Ten patients were managed in the three-session protocol, and 18 patients were managed in the clinically treated group. There was no significant difference in clinical success rates between groups, 80% and 61%, respectively. The three-session protocol group trended toward a lower total biliary drain indwell time (median 49 days) compared with the clinically treated group (median 89 days), P = .089. Our study suggests that a three-session dilation protocol following transplant-related biliary stricture may decrease total biliary drainage time for some patients.

关键词： balloon dilation biliary obstruction children percutaneous transhepatic cholangiogram transplant complications

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Pancreatic cancer seeding of percutaneous needle tract

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Radiology Case Reports 2017年第1期12卷 50-53页

作者： Zhou, Qiao Murthy, Shashi Vingan, Harlan Department of Radiology Eastern Virginia Medical School 6800 Gresham Dr Norfolk 23510 VA United States

A 65-year old African-American female presents with biliary ductal dilatation due to an obstructive pancreatic head mass. percutaneous transhepatic cholangiogram performed and biliary drainage catheter placement for decompression of the biliary system. The patient had a Whipple procedure performed several months later. On follow up CT imaging, there was interval development and enlargement of a subcutaneous lesion by the right oblique muscles. Biopsy of this lesion revealed pancreatic adenocarcinoma from percutaneous seeding of the transhepatic needle tract. © 2016 The Authors

关键词： Biliary drainage Pancreatic cancer percutaneous transhepatic cholangiogram Seeding

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Diagnosis and Management of Postoperative Biliary Leaks

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SEMINARS IN INTERVENTIONAL RADIOLOGY 2016年第4期33卷 307-312页

作者： Nikpour, Arian M. Knebel, R. Justin Cheng, Danny Univ Calif Davis Sch Med Davis Med Ctr Dept RadiolDiv Intervent Radiol Sacramento CA 95817 USA

Postoperative biliary leaks have become more common in the past three decades since the development of laparoscopic biliary surgery. The role of the radiologist and interventional radiologist is important in the diagnosis and treatment of such complications, and can play an adjunctive role in the definitive surgical repair. Ultrasound, computed tomography, magnetic resonance cholangiopancreatography, nuclear medicine cholescintigraphy studies, and percutaneous transhepatic cholangiograms (PTC) are the various imaging modalities used for diagnosis. Interventional radiology treatment involves percutaneous drainage of bilomas, characterization of the biliary tree and assessment of the site of ductal injury with PTC, and biliary diversion with external biliary drainage.

关键词： biliary leak biloma percutaneous transhepatic cholangiogram cholecystectomy interventional radiology

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Benign Biliary Strictures

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SEMINARS IN INTERVENTIONAL RADIOLOGY 2016年第4期33卷 297-306页

作者： Altman, Ashley Zangan, Steven M. Univ Chicago Dept Radiol 5841 South Maryland Ave MC2026 Chicago IL 60637 USA

Differentiating benign and malignant biliary strictures is a challenging and important clinical scenario. The typical presentation is indolent and involves elevation of liver enzymes, constitutional symptoms, and obstructive jaundice with or Without superimposed or recurrent cholangitis. While overall the most common causes of biliary strictures are malignant, including cholangiocarcinoma and pancreatic adenocarcinoma, benign strictures encompass a wide spectrum of etiologies including iatrogenic, autoimmune, infectious, inflammatory, and congenital. Imaging plays a crucial role in evaluating strictures, characterizing their extent, and providing clues to the ultimate source of biliary obstruction. While ultrasound is a good screening tool for biliary ductal dilatation, it is limited by a poor negative predictive value. Magnetic resonance cholangiopancreatography is more than 95% sensitive and specific for detecting biliary strictures with the benefit of precise anatomic localization. Other commonly employed imaging modalities include endoscopic retrograde cholangiopancreatography with endoscopic ultrasound, contrast-enhanced CT, and cholangiography. First-line treatment of benign biliary strictures is endoscopic dilation and stenting. In patients with anatomy that precludes endoscopic cannulation, percutaneous biliary drain insertion and balloon dilation is preferred.

关键词： biliary strictures benign stricture percutaneous transhepatic cholangiogram percutaneous biliary drainage interventional radiology

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Choledocholithiasis: Diagnosis and Management

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TECHNIQUES IN VASCULAR AND INTERVENTIONAL RADIOLOGY 2015年第4期18卷 244-255页

作者： Copelan, Alexander Kapoor, Baljendra S. William Beaumont Hosp Radiol Royal Oak MI 48072 USA Cleveland Clin Imaging Inst Cleveland OH 44106 USA

Common bile duct stones constitute the main etiology of nonmalignant biliary obstruction. Endoscopic retrieval of common bile duct stones has been adopted as the primary treatment modality for extrahepatic biliary stones. However, endoscopic therapy may fail in patients who have had previous gastrointestinal tract surgeries, including partial gastrectomy with Billroth II reconstruction or bilioenteric anastomosis, or in patients with anatomical anomalies such as a duodenal periampullary diverticulum, which makes the biliary duct difficult to access via an endoscopic approach. Endoscopic therapy may also not be suitable for hepatolithiasis with large and impacted stones. In such situations, a percutaneous approach is generally the best option. A variety of percutaneous techniques are available for removal of intrahepatic and extrahepatic bile duct stones via transhepatic approach and 1-tube tract. These techniques include extraction, fragmentation, and expulsion of stones into the duodenum. In this article, clinical presentations, imaging modalities, and different management options, particularly percutaneous techniques for the management of choledocholithiasis or hepatolithiasis, are reviewed. Published by Elsevier Inc.

关键词： Choledocholithiasis percutaneous transhepatic cholangiogram percutaneous biliary transhepatic cholangitis

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