Percutaneous biliary drainage

Percutaneous Transbepatic Cholangiography and Percutaneous Biliary Drainage... 

The most common indications for a PTC are (1) the evaluation of obstructive jaundice of unknown etiology, (2) following unsuccessful ERC, and (3) as the initial stage of percutaneous biliary drainage (PBD). PTC and PBD are performed as sterile procedures using a fiuoroscopic unit, ideally one equipped with a C-arm and a tilting table. 

Funaki B, Zaleski GX, Straus CA, Leef JA, Funaki AN, Lorenz J, Farrell TA, Rosenblum JD (2000) Percutaneous biliary drainage in patients with non-dilated intrahepatic bile ducts. AJR Am J Roentgenol 175 268 Gabelmann A, Hamid H, Brambs HJ et al (2001) Metallic stents in benign biliary strictures long-term effectiveness and interventional management of stent occlusion. AJR Am J Roentgenol 177 813 17... 

McNicholas MMJ, LeeMJ, Dawson SJ et al (1994) Complications of percutaneous biliary drainage and intervention. Semin Intervent Radiol 11 242-253 Mechkov G, Vasileva Z, Krustev Z et al (1987) Potentials and limits of ultrasonic diagnosis in gastroenterology. Vutr Boles 26 1-5... 

Additional clinical applications in the body that can benefit from C-arm CT are drainages and punctures. When performing percutaneous biliary drainage procedures, Froehlich et al. (2000), for example, found that C-arm CT resulted in decreased procedure and fluoroscopy times. C-arm CT can also be beneficial for complicated transjugular intrahepatic portosystemic shunt cases (SzE et al. 2006). Binkert et al. (2006) described another successful application for C-arm devices providing both 2D and 3D imaging. They used the 3D cross-sectional information for needle placement and 2D fluoroscopy to perform embolization of translum-bar type II endoleaks. 

Froelich JJ, Wagner H-J, Ishaque N, et al. (2000) Comparison of C-arm CT fluoroscopy and conventional fluoroscopy for percutaneous biliary drainage procedures. J Vase Intervent Radiol 11 477-482... 

Falk GW (2001) Gastroesophageal reflux disease and Barrett s esophagus. Endoscopy 33 109-118 Fotheringham T, Abbass S, Varghese JC et al. (2002) Displacement of occluded plastic endoprostheses into the duodenum during percutaneous biliary drainage description of an under-reported technique. Clin Radiol 57 1113-1117... 

Zajko, A.B., Bron, KM., Campbell, W.L., Behai, R., van Thiel, D.H., Starzl, Th.E. Percutaneous transhepatic cholangiography and biliary drainage after liver transplantation a five-year experience. Gastrointest. Radiol. 1987 12 137-143... 

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

The need for biliary drainage in children is less frequent than in adults however, there are a number of indications for performing a percutaneous tran-shepatic cholangiogram (PTC) (Diament et al. 1985). The most common indications for PTC is obstructive jaundice resulting from either a malignancy, most commonly rhabdomyosarcoma of the bile ducts or pancreas and neuroblastoma, or post liver transplantation. Cholithiasis is less frequently a causative agent (Lorenz et al. 2001 Roebuck and Stanley 2000 Rose et al. 2001). Cholangitis, which is a relatively common indication for PTC in adults, is rarely seen in children. 

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... 

Savader SJ, Trerotola SO, Merine DS, Venbrux AC, Oster-man FA (1992) Hemobilia after percutaneous transhepatic biliary drainage treatment with transcatheter embolo-therapy. J Vase Intervent Radiol 3 345-352... 

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... 

Plastic endoprosthesis for biliary drainage were introduced in 1978 by Burcharth (1978) and Pereiras et al. (1978). Several types are available for percutaneous and endoscopic use. Common examples include the hammer endoprosthesis (William Cook), and the Carey-Coons endoprosthesis (Boston Scientific). Most plastic endoprostheses have sideholes at either end and are of large caliber to ensure efficient biliary drainage. 

Complications of percutaneous biliary interventions can be divided into procedural complications and late complications. Most procedural comphcations are related to the initial biliary drainage with mortality ranging from 0% to2.8%, with major complications occurring in 3.5%-9.5%. Minor complications such as mild self-limiting hemobilia, fever, and transient bacteremia occur in up to 66% of patients (Winick et al. 2001 Hamlin et al. 1986 McNicholas et al. 1994 Mueller et al. 1982). 

Ferrucci JT Jr, Mueller PR, Harbin WP (1980) Percutaneous transhepatic biliary drainage. Technique, results and applications. Radiology 135 1 13... 

Wig JD, Kumar H, Suri S, Gupta NM (1999) Usefulness of percutaneous transhepatic biliary drainage in patients with surgical jaundice - a prospective randomised study. J Assoc Physicians India 47 271-274 Winick AB, Waybill PN, Venbrux AC (2001) Complications of percutaneous transhepatic biliary interventions. Tech Vase Interv Radiol 4 200-206... 

A study conducted in patients with obstructive jaundice [31] indicated that addition of Tinospora cordifolia to routine surgical procedures increased survival rates. Thus, when compared to a mortality of 61.5% (n = 13) in patients who underwent percutaneous transhepatic biliary drainage alone, addition of Tinospora cordifolia reduced this mortality to 25% (n = 16). Similarly, in another group where percutaneous transhepatic biliary drainage was not performed, Tinospora cordifolia reduced mortality from 57.1% (n = 14) in controls to 14.2% (n = 14). Treatment with Tinospora cordifolia led to an increase in PMN functions (30.4 3.0% phagocytosis and 272 62% IKC) as compared to 20.0 8.5% phagocytosis and 11.2 3.1% IKC in control patients. 

Observational studies When remifentanil was given by intravenous infusion pump at a rate of 0.1-0.15 micrograms/kg/minute to 186 patients undergoing percutaneous transhepatic biliary drainage (mean total dose 116 micrograms), 10% had transient bradycardia and 2% had respiratory depression [160 ]. 

Burke DR, Lewis CA, Cardella JF, et al (2003). Quality improvement guidelines for percutaneous transhepatic cholangiography and biliary drainage. J Vase Interv Radiol 14 5243-246... 

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... 

Lamaris JS,Stoker J,Dees Jet al (1987) Nonsurgical palliative treatment of patients with malignant biliary obstruction. The place of endoscopic and percutaneous drainage. Clin Radiol 38 603-608... 

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