Biliary catheter

Fig. 1.3a-c. Transhepatic internal/external biliary drainage of malignant distal common bile duct (CBD) stricture due to pancreatic cancer, a Opacification of the right peripheral duct by a percutaneous puncture shows irregular stricture of the distal CBD (arrow), b Using a combination of 0.038-in. guidewire and a 5-F catheter, the CBD stricture was negotiated, c An 8-F multi-sidehole internal/external biliary catheter was placed over the wire... 

Gallo-Torres et al. (1979) described in detail a method for the bioassay of antisecretory activity in the conscious rat with acute gastric fistula with additional collection of the biliary and pancreatic secretion by means of a catheter in the common bile duct. The gastric secretions are collected by gravity via a cannula in the most gravity dependent site of the glandular stomach. 

G. Percutaneous catheter drainage of amebic liver abscesses with and without intrahepatic biliary communication a comparative study. Europ. X Radiol. 1995 20 61-64... 

Endoscopic retrograde cholangiopancreatography (FRCP) is an important procedure that is used to evaluate and treat diseases of the biliary tree and pancreas. By injecting contrast agents throngh a catheter... 

PTC is not only used for catheter drainage but it also allows for dilatation of strictures of the biliary tree, which in children is mostly in cases of biliary-enteric anastomoses (Sze and Esquivel 2002). The advantage of balloon dilatation of strictures is the relatively minimal invasive approach and that, if dilatation fails, surgical options remain viable. Lorenz et al. (2005) reported their experience in 19 children over a 7-year period. In their study, 58% of patients showed a patent biliary-enteric anastomosis after 1 year (continued patency ranged from 1.4 to 5.4 years, mean patency 3.6 years). 

Another approach to the treatment of biliary obstructive jaundice is the use of endoscopic antegrade cholangiography (ERC). The main advantage of PTC over ERC is that it is a percutaneous technique that allows for easier access to the catheter in case of obstruction or infection. Secondly, PTC will be successful in cases of complete obstruction of the common bile duct because then external biliary drainage can be performed. Finally, ERC has a higher number of complications, such as pancreatitis and perforation, especially when the operator does not do the procedure on a regular basis. This is even more the case in children inhere special scopes are needed to perform a successful ERC. This procedure will therefore only be performed in specialized centres. The advantage of ERC over PTC lies mainly... 

Relief of biliary obstruction, previously wholly a surgical procedure, is now accomplished by percutaneous or endoscopic techniques. Three types of drainage procedures are performed (1) external drainage, in which a percutaneous catheter is placed into the bile ducts above the obstructing lesion (2) internal/external drainage in which a percutaneously placed catheter is placed with the tip in the duodenum and (3) internal drainage using a totally internal... 

Fig. 1.6a-d. Rendezvous procedure for a distal CBD stricture with failed endoscopic retrograde cholangiography, a CT shows a distal biliary obstruction along with multiple liver metastasis (arrow), b The stricture of the distal common bile duct was negotiated and an 8-F multi-sidehole catheter was inserted (arrow). This facilitated endoscopic bile duct cannulation (c) and subsequent stent placement (d)... 

The cholangiographic findings during ERCP should be used to aid stent selection. The length of the chosen stent should be based on measurements obtained with a ruled catheter or wire that can be pulled through the stricture (Seibert 1997). Ideally, plastic stents should completely span the stricture and protrude 1-2 cm from the ampulla. Performance of a biliary sphincterotomy prior to stent placement may reduce the incidence of acute pancreatitis in patients who have a proximal stricture of the bile duct (Tamsky et al. 1997). Other reports suggest that the routine use of biliary sphincterotomy increases the duration of the procedure as well as the complication rate (Margulies et al. 1999). 

Laser catheters based on dye lasers and Nd YAG lasers have been used for laser lithotripsy, the shattering of stones inside the body. In this case, the catheter is inserted into the body and the distal tip of the power fiber is brought in contact with the stone. Dye laser. Ho YAG, or frequency-doubled Nd YAG laser pulses sent through these quartz fibers are absorbed in the stone surface and generate hot plasma. The resulting shock waves rapidly shatter the stone. This procedure is particularly useful in cases where other methods such as shock wave lithotripsy cannot be applied. Laser lithotripsy has been successfully applied on patients for the removal of urinary stones or biliary stones. (Comment an identical procedure has been used in otolaryngology for salivary gland calculi.)... 

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