Predictive Factors for Symptomatic Dislodgement of Percutaneous Transhepatic Biliary Drainage Catheter in Patients with Malignant Biliary Obstruction

Hee Jeong Yu,Jung Gu Park,Gyoo Sik Jung,Kwang Il Seo,Hyun Joon Park,Jong Hyouk Yun 대한영상의학회 2023 대한영상의학회지 Vol.84 No.6

Purpose To evaluate the factors that predict symptomatic dislodgement of a percutaneous transhepatic biliary drainage (PTBD) catheter in patients with malignant biliary obstruction. Materials and Methods This retrospective study included 572 patients with malignant biliary obstruction who underwent 733 PTBD catheter insertions between January 2010 and February 2015. The duration of catheter placement, approach site, location of the catheter tip, insertion angle, presence of a closed-loop pigtail, and tube diameter were evaluated. Results During the follow-up period, 224 PTBD catheter dislodgements (30.56%) were observed in 157 patients. Among them, 146 (19.92%) were symptomatic. The mean duration from catheter insertion until dislodgement was 32 days (range: 1–233 days). Male (odds ratio [OR]: 1.636, 95% confidence interval [CI]: 1.131–2.367, p = 0.009), right-sided approach (OR: 1.567, 95% CI: 1.080–2.274, p = 0.018), increased insertion angle (OR: 1.015, 95% CI: 1.005–1.026, p = 0.005), and incomplete closed-loop pigtail formation (OR: 1.672, 95% CI: 1.098–2.545, p = 0.016) were independent factors predictive of symptomatic dislodgement of a PTBD catheter. Conclusion Factors predictive of symptomatic catheter dislodgement included male sex, a right-sided approach, increased insertion angle, and incomplete closed-loop pigtail formation.

Treatment of Malignant Biliary Obstruction with a PTFE-Covered Self-Expandable Nitinol Stent

Han, Young-Min,Kwak, Hyo-Sung,Jin, Gong-Yong,Lee, Seung-Ok,Chung, Gyung-Ho unknown 2007 KOREAN JOURNAL OF RADIOLOGY Vol.8 No.5

<P><B>Objective</B></P><P>We wanted to determine the technical and clinical efficacy of using a PTFE-covered self-expandable nitinol stent for the palliative treatment of malignant biliary obstruction.</P><P><B>Materials and Methods</B></P><P>Thirty-seven patients with common bile duct strictures caused by malignant disease were treated by placing a total of 37 nitinol PTFE stents. These stents were covered with PTFE with the exception of the last 5 mm at each end; the stent had an unconstrained diameter of 10 mm and a total length of 50-80 mm. The patient survival rate and stent patency rate were calculated by performing Kaplan-Meier survival analysis. The bilirubin, serum amylase and lipase levels before and after stent placement were measured and then compared using a Wilcoxon signed-rank test. The average follow-up duration was 27.9 weeks (range: 2-81 weeks).</P><P><B>Results</B></P><P>Placement was successful in all cases. Seventy-six percent of the patients (28/37) experienced adequate palliative drainage for the remainder of their lives. There were no immediate complications. Three patients demonstrated stent sludge occlusion that required PTBD (percutaneous transhepatic biliary drainage) irrigation. Two patients experienced delayed stent migration with stone formation at 7 and 27 weeks of follow-up, respectively. Stent insertion resulted in acute elevations of the amylase and lipase levels one day after stent insertion in 11 patients in spite of performing endoscopic sphincterotomy (4/6). The bilirubin levels were significantly reduced one week after stent insertion (<I>p</I> < 0.01). The 30-day mortality rate was 8% (3/37), and the survival rates were 49% and 27% at 20 and 50 weeks, respectively. The primary stent patency rates were 85%, and 78% at 20 and 50 weeks, respectively.</P><P><B>Conclusion</B></P><P>The PTFE-covered self-expandable nitinol stent is safe to use with acceptable complication rates. This study is similar to the previous studies with regard to comparing the patency rates and survival rates.</P>

담관을 침범한 간세포암을 경동맥 화학색전술로 치료한 증례

김희언 ( Hee Yeon Kim ),김창욱 ( Chang Wook Kim ),이창돈 ( Chang Don Lee ),이수림 ( Soo Lim Lee ),원유동 ( Yoo Dong Won ),김예일 ( Ye Il Kim ) 대한간암학회 2013 대한간암학회지 Vol.13 No.2

A 53-year-old female patient visited our hospital complaining of intermittent right upper quadrant pain for 6 months. Computed tomography (CT) scan revealed an irregular shaped tumor at segment 4 of the liver with biliary tumor thrombi extending into the common bile duct. Percutaneous transhepatic biliary drainage was done for decompression of bile duct dilatation. The patient underwent 6 sessions of transarterial chemoembolization (TACE). Partial response was obtained shortly after TACE. However, regrowth of intraductal tumor resulted in an obstructive jaundice. After a slight decompression of the obstructive jaundice, the patient underwent TACE. Jaundice temporarily worsened following the TACE, but improved, and follow-up CT demonstrated some shrinkage of the intraductal mass. This case indicates that obstructive-type jaundice may not be a contraindication for TACE, and aggressive TACE may improve prognoses of patients with hepatocellular carcinoma and biliary tumor thrombi.

Review of Simultaneous Double Stenting Using Endoscopic Ultrasound-Guided Biliary Drainage Techniques in Combined Gastric Outlet and Biliary Obstructions

Hao Chi Zhang,Monica Tamil,Keshav Kukreja,Shashideep Singhal 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.2

Concomitant malignant gastric outlet obstruction and biliary obstruction may occur in patients with advanced cancers affecting theseanatomical regions. This scenario presents a unique challenge to the endoscopist in selecting an optimal management approach. Wesought to determine the effcacy and safety of endoscopic techniques for treating simultaneous gastric outlet and biliary obstruction(GOBO) with endoscopic ultrasound (EUS) guidance for biliary drainage. An extensive literature search for peer-reviewed publishedcases yielded 6 unique case series that either focused on or included the use of EUS-guided biliary drainage (EUS-BD) withsimultaneous gastroduodenal stenting. In our composite analysis, a total of 51 patients underwent simultaneous biliary drainagethrough EUS, with an overall reported technical success rate of 100% for both duodenal stenting and biliary drainage. EUS-guidedcholedochoduodenostomy or EUS-guided hepaticogastrostomy was employed as the initial technique. In 34 cases in which clinicalsuccess was ascribed, 100% derived clinical benefit. The common adverse effects of double stenting included cholangitis, stent migration,bleeding, food impaction, and pancreatitis. We conclude that simultaneous double stenting with EUS-BD and gastroduodenal stentingfor GOBO is associated with high success rates. It is a feasible and practical alternative to percutaneous biliary drainage or surgery forpalliation in patients with associated advanced malignancies.

악성 담관 폐쇄에서 내시경적 스텐트 삽입술

김형욱,강대환 대한소화기내시경학회 2009 Clinical Endoscopy Vol.39 No.1

Cholangiocarcinoma has an extremely poor prognosis and the majority of patients have an incurable disease at the time of presentation. These patients should be offered palliative drainage management. The aims of palliation are to prevent cholangitis or bile peritonitis in the course of follow-up or chemotherapy, and to preserve the functional volume of the liver as much as possible. Endoscopic or percutaneous drainage has become increasingly important in the palliative care of patients with unresectable cholangiocarcinoma. Compared to the percutaneous approach, endoscopic biliary stenting is less invasive, more comfortable, and results in a reduced hospital stay. Therefore, endoscopic biliary stenting should be considered the first-line therapy for jaundice palliation in unresectable cholangiocarcinoma. 담도암은 예후가 아주 불량하며 환자의 대부분이 진단 당시에 수술이 불가능한 경우가 많다. 이러한 환자에서 담도 배액을 통한 대증적인 치료법이 제공되어야 한다. 담도 배액을 통한 대증 치료의 목적은 생존기간이나 항암치료 동안 담도염이나 담즙성 복막염을 예방하고 가능한 많은 간기능을 보존하는 것이다. 내시경 혹은 경피경간을 통한 담도 배액이 수술이 불가능한 환자에서 더욱 중요한 역할을 하고 있다. 경피경간담도배액술에 비해 내시경을 이용한 담도 배액은 덜 침습적이며 환자가 더욱 편리하며 입원기간의 단축과 같은 장점이 있다. 따라서 내시경을 이용한 담도 배액은 수술이 불가능한 담도암 환자에서 황달의 경감을 위해 최선의 치료법으로 고려되어야 한다.

Percutaneous Placement of Self-Expandable Metallic Stents in Patients with Obstructive Jaundice Secondary to Metastatic Gastric Cancer after Gastrectomy

홍현표,서태석,차인호,유정림,목영재,오주형,권세환,김삼수,김승권 대한영상의학회 2013 Korean Journal of Radiology Vol.14 No.5

Objective: To evaluate the outcomes of patients undergoing percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy. Materials and Methods: Fifty patients (mean age, 62.4 years; range, 27-86 years) who underwent percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy were included. The technical success rate, clinical success rate, complication rate, stent patency, patient survival and factors associated with stent patency were being evaluated. Results: The median interval between the gastrectomy and stent placement was 23.1 months (range, 3.9-94.6 months). The 50 patients received a total of 65 stents without any major procedure-related complications. Technical success was achieved in all patients. The mean total serum bilirubin level, which had been 7.19 mg/dL ± 6.8 before stent insertion, decreased to 4.58 mg/dL ± 5.4 during the first week of follow-up (p < 0.001). Clinical success was achieved in 42 patients (84%). Percutaneous transhepatic biliary drainage catheters were removed from 45 patients (90%). Infectious complications were noted in two patients (4%), and stent malfunction occurred in seven patients (14%). The median stent patency was 233 ± 99 days, and the median patient survival was 179 ± 83 days. Total serum bilirubin level after stenting was an independent factor for stent patency (p = 0.009). Conclusion: Percutaneous transhepatic placement of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy is a technically feasible and clinically effective palliative procedure.

담도 폐쇄로 인한 담도염 환자에 있어서의 담즙 내 세균에 대한 연구

성인경(In Kyung Sung),이규택(Kyu Taek Lee),이종균(Jong Kyun Lee),김영호(Young Ho Kim),이석호(Seok Ho Lee),송희정(Hee Jung Son),이준혁(Joon Hyoek Lee),이풍렬(Poong Lyunl Rhee),김재준(Jae Jun Kim),고광철(Kwang Chul Koh),백승운(Seung Wo 대한내과학회 1998 대한내과학회지 Vol.55 No.1

N/A has been focused on the Enterococcus due to increasing in incidence of nosocomial infection and resistance to broad range of antimicrobial agents of this organism The purpose of this study was to analyse the bacteriologic features of bile in patients with cholangitis. Methods : Bacteriological examination was made of bile from 356 patients with cholangitis due to biliary tract obstruction, 105 of them with common bile duct stone and 251 of them with malignant disease. Bile specimens were taken during percutaneous transhepatic biliary drainage of endoscopic nasobiliary drainage. The specimens were cultured aerobically and anaerobically and then the anti- biotic sensitivity test was done. Results: The overall positive culture rates was 81.4%. There was significant difference in positive culture rates between the patients with common bile duct stone and the patients with malignant disease,(88.5% vs 78.4%, p<0.05) But there was no significant difference in bacteriological features between the patients with common bile duct stone and the patients with malignant disease. The commonly isolated organisms were Enterococcus (21.6%), E.coli(19.7%), and Klebsiella(17.2%) respectively. The isolation rate of anaerobes were only 2%. The rate of polymicrobial infection was 78.1%. The rates of 3rd cephalosporins-resistant Klebsiella were over 30%. The rate of ampicillin-resistant Enterococcus was 35%. The rate of gentamicin-resistant Enterococcus was 28%. Conclusion : This study shows that 1) many micro- organisms have resistance to a broad range of antimicrobial agents, and 2) the antibiotic coverage against Enterococcus should be considered for the treatment of cholangitis due to the increasing tendency to Enterococcus infection.

결핵성 임파선증으로 인한 담도계 폐쇄 1예 보고

정호술(Ho Sool Jeong),고영관(Young Gwan Ko),홍성화(Sung Wha Hong) 대한외과학회 1993 Annals of Surgical Treatment and Research Vol.44 No.5

Usefulness of Endoscopic Transpapillary Tissue Sampling for Malignant Biliary Strictures and Predictive Factors of Diagnostic Accuracy

Hiroki Tanaka,Shimpei Matsusaki,Youichirou Baba,Yoshiaki Isono,Tomohiro Sase,Hiroshi Okano,Tomonori Saito,Katsumi Mukai,Tetsuya Murata,Hiroki Taoka 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.2

Background/Aims: It is sometimes difficult to distinguish between malignant and benign biliary strictures using imaging studiesalone, and pathological diagnosis is necessary. The aim of this study was to determine the usefulness of endoscopic transpapillary tissuesampling and factors predictive of diagnostic accuracy. Methods: From April 2008 to December 2014, 136 patients underwent endoscopic transpapillary tissue sampling for malignantbiliary strictures. The cytological and histological findings were reported as negative, suspicious, or positive. Suspicious and positivefindings were defined as pathologically positive. Results: The sensitivity was 65.0% for forceps biopsy, 49.5% for brush cytology, 46.2% for bile aspiration cytology, and 21.9% forendoscopic nasobiliary drainage cytology. The combination of these procedures improved the sensitivity (72.8%). Endoscopictranspapillary tissue sampling was more sensitive for lesions of biliary origin (91.4%) than for extrabiliary lesions (66.3%). In surgicalcases, the sensitivity for tumors with an infiltrative growth pattern (53.3%) was significantly lower than for a tumor with an expandingor intermediate growth pattern (87.5%). Conclusions: Combining procedures can improve diagnostic accuracy. It may be possible to predict the sensitivity of endoscopictranspapillary tissue sampling by evaluating the etiology and tumor growth pattern using preoperative imaging studies.