Percutaneous transhepatic image-guided interventions for malignant biliary obstructions: Current status

Adam Hatzidakis, Miltiadis Krokidis

Abstract


A malignant biliary obstruction (MBO) occurs when there is a blockage of the bile outflow towards the duodenum due to a malignant tumour. The most common tumours that cause MBO with direct invasion of the biliary tree are pancreatic carcinoma and cholangiocarcinoma. The biliary tree may also be blocked from tumours that cause external compression, such as enlarged hilar or ampulary lymph nodes or in some cases of hepatocellular, gastric or gallbladder cancer. Surgery is the treatment of choice if the disease is at an early stage and adjacent structures are not infiltrated. Otherwise patients will receive palliative treatment for quality of life improvement. Percutaneous transhepatic image-guided biliary interventions offer a minimal invasive approach that decompresses the blocked biliary system and have an established role in the management of both operable and inoperable patients with MBO.

A variety of devices and techniques have been developed for this purpose, including the use of internal and external drains, plastic, bare metallic and covered metallic stents, biopsy forceps and unilateral or bilateral, one- or two stage- approach. The purpose of this review article is to offer a global overview of the interventional radiology role in such patients and to discuss the latest developments.


Keywords


percutaneous interventions; biliary malignancies; biliary drainage; metallic stenting; interventional radiology

Full Text:

PDF

References


Wade TP, Prasad CN, Virgo KS, et al. Experience with distal bile duct cancers in U.S. Veterans Affairs hospitals: 1987-1991. J Surg Oncol 1997; 64: 242-245.

Fong Y, Blumgart LH, Lin E, et al. Outcome of treatment for distal bile duct cancer. Br J Surg 1996; 83: 1712-1715.

Krokidis M, Hatzidakis A. Percutaneous minimally invasive treatment of malignant biliary strictures: Current status. Cardiovasc Intervent Radiol 2014; 37(2): 316-323.

Assimakopoulos SF, Scopa CD, Vagianos CE. Pathophysiology of increased intestinal permeability in obstructive jaundice. World J Gastroenterol 2007; 13: 6458-6464.

Walter T, Ho CS, Horgan AM, et al. Endoscopic or percutaneous biliary drainage for Klatskin tumors? J Vasc Interv Radiol 2013; 24(1): 113-121.

Kloek JJ, van der Gaag NA, Aziz Y, et al. Endoscopic and percutaneous preoperative biliary drainage in patients with suspected hilar cholangiocarcinoma. J Gastrointest Surg 2010; 14(1): 119-125.

Pancreatic Section, British Society of Gastroenterology, Pancreatic Society of Great Britain and Ireland, Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, Royal College of Pathologists, Special Interest Group for Gastro-intestinal Radiology. Guidelines for the management of patients with pancreatic cancer periampullary and ampullary carcinomas. Gut 2005; 54 (suppl 5): v1–v16.

Lacomis JM, Baron RL, Oliver JH, et al. Cholangiocarcinoma: Delayed CT contrast enhancement patterns. Radiology 1997; 203: 98-104.

Guibaud L, Bret PM, Reinhold C, et al. Bile duct obstruction and choledocholithiasis: Diagnosis with MR cholangiography. Radiology 1995; 197: 109- 115.

Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet 1975; 140: 170-178.

Okuda K, Tanikawa K, Emura T, et al. Nonsurgical, percutaneous transhepatic cholangiography-diagnostic significance in medical problems of the liver. Am J Dig Dis 1974; 19(1): 21-36.

Bismuth H, Castaing D, Traynor O. Resection or palliation: Priority of surgery in the treatment of hilar cancer. World J Surg 1988; 12(1): 39-47.

Nilsson U, Evander A, Ihse I, et al. Percutaneous transhepatic cholangiography and drainage. Risks and complications. Acta Radiol Diagn (Stockh) 1983; 24(6): 433-439.

Hatzidakis A, Adam A. The interventional radiological management of cholangio-carcinoma. Clinical Radiology 2003; 58: 91-96.

Fritscher-Ravens A, Broering DC, Sriram PVJ, et al. EUSguided fine-needle cytodiagnosis of hilar cholangiocarcinoma: A case series. Gastrointest Endosc 2000; 52: 534-540.

De Bellis M, Sherman S, Fogel EL, et al. Tissue sampling at ERCP in suspected malignant biliary strictures (part 2). Gastrointest Endosc 2002; 56: 720-730.

Park JG, Jung GS, Yun JH, et al. Percutaneous transluminal forceps biopsy in patients suspected of having malignant biliary obstruction: factors influencing the outcomes of 271 patients. Eur Radiol 2017; 27. doi: 10.1007/s00330-017-4796-x. [Epub ahead of print]

Adam A. Metallic biliary endoprostheses. Cardiovasc Intervent Radiol 1994; 17: 127-132.

Rossi P, Bezzi M, Rossi M, et al. Metallic stents in malignant biliary obstruction: Results of a Multicenter European Study of 240 patients. J Vasc Interv Radiol 1994; 5: 279-285.

Hatzidakis A, Tsetis D, Chrysou E, et al. Nitinol stents for palliative treatment of malignant obstructive jaundice. Should we stent the sphincter of Oddi in every case? Cardiovasc Intervent Radiol 2001; 24: 245-248.

Lammer J, Hausegger KA, Flückiger F, et al. Common bile duct obstruction due to malignancy: Treatment with plastic versus metal stents. Radiology 1996; 201(1): 167-172.

Brountzos EN, Ptochis N, Panagiotou I, et al. A survival analysis of patients with malignant biliary strictures treated by percutaneous metallic stenting. Cardiovasc Intervent Radiol 2007; 30:66-73.

Kaskarelis IS, Papadaki MG, Papageorgiou GN, et al. Long-term follow-up in patients with malignant biliary obstruction after percutaneous placement of uncovered wallstent endoprostheses. Acta Radiol 1999; 40: 528-533.

Hatzidakis A, Krokidis M, Kalbakis K, et al. ePTFE/FEP-covered metallic stents for palliation of malignant biliary disease: can tumor ingrowth be prevented? Cardiovasc Intervent Radiol 2007; 30(5): 950-958.

Hausegger KA, Kleinert R, Lammer J, et al. Biliary obstruction: Histologic findings after treatment with self-expandable stents. Radiology 1992; 185: 461-464.

Boguth L, Tatalovic S, Antonucci F, et al. Malignant biliary obstruction: Clinical and histopathologic correlation after treatment with self-expanding metal prostheses. Radiology 1994; 192: 669-674.

Krokidis M, Hatzidakis A. ePTFE/FEP covered met­al stents in malignant biliary disease. In: Fanelli F (ed). Biliary Disease and Advanced Therapies using ePTFE/FEP Covered Stents. Minerva Medica Turin 2014: 23-38.

Saito H, Sakurai Y, Takamura A, et al. Biliary endoprosthesis using Gore Tex covered expandable metallic stents: Preliminary clinical evaluation. [Article in Japanese]. Nihon Igaku Hoshasen Gakkai Zasshi 1994; 54(2): 180-182.

Thurnher SA, Lammer J, Thurnher MM, et al. Covered self-expanding transhepatic biliary stents: Clinical pilot study. Cardiovasc Intervent Radiol 1996; 19: 10-14.

Rossi P, Bezzi M, Salvatori FM, et al. Clinical experience with covered Wallstents for biliary malignancies: 23-month follow-up. Cardiovasc Intervent Radiol 1997; 20: 441-447.

Hausegger KA, Thurnher S, Bodendorfer G, et al. Treatment of malignant biliary obstruction with polyurethane covered Wallstents. AJR Am J Roentgenol 1998; 170(2): 403-408.

Kanasaki S, Furukawa A, Kane T, et al. Polyurethane- covered nitinol Strecker stents as primary palliative treatment of malignant biliary obstruction. Cardiovasc Intervent Radiol 2000; 23: 114-120.

Miyayama S, Matsui O, Terayama T, et al. Covered Gianturco stents for malignant biliary obstruction: Preliminary clinical evaluation. J Vasc Interv Radiol 1997; 8: 641-648.

Han YM, Jin GY, Lee S, et al. Flared Polyurethane-covered Self expandable Nitinol Stent for Malignant Biliary Obstruction. J Vasc Interv Radiol 2003; 14: 1291-1301.

Isayama H, Komatsu Y, Tsujino T, et al. Polyurethane-covered metal stent for management of distal malignant biliary obstruction. Gastrointest Endosc 2002; 55: 366-370.

Isayama H, Komatsu Y, Tsujino T, et al. A prospective randomized study of “covered” vs. “uncovered” diamond stents for the management of distal malignant biliary obstruction. Gut 2004; 53: 729-734.

Krokidis M, Fanelli F, Orgera G, et al. Percutaneous palliation of pancreatic head cancer: Randomized comparison of ePTFE/FEP-covered vs. uncovered nitinol biliary stents. Cardiovasc Intervent Radiol 2011; 34(2): 352-361.

Krokidis M, Fanelli F, Orgera G, et al. Percutaneous treatment of malignant jaundice due to extrahepatic cholangiocarcinoma: Covered Viabil stent vs. uncovered Wallstents. Cardiovasc Intervent Radiol 2010; 33: 97-106.

Krokidis M, Orgera G, Fanelli F, et al. Covered biliary metal stents: Which, where, when? Gastrointest Endosc 2011; 74(5): 173-1174.

Adam A, Chetty N, Roddie M, et al. Self-expandable stainless steel endoprostheses for treatment of malignant bile duct obstruction. AJR Am J Roentgenol 1991; 156(2): 321-325.

Hatzidakis AA, Charonitakis E, Athanasiou A, et al. Sedation and analgesia in patients undergoing percutaneous transhepatic biliary drainage. Clin Radiol 2003; 58(2): 121-127.

Inal M, Akgul E, Seydaoglu G. Percutaneous placement of biliary metallic stents in patients with malignant hilar obstruction: Unilobar vs. bilobar drainage. J Vasc Interv Radiol 2003;14: 1409-1416.

Li M, Wu W, Yin Z, et al. Unilateral versus bilateral biliary drainage for malignant hilar obstruction: A systematic review and meta-analysis. [Article in Chinese] Zhonghua Gan Zang Bing Za Zhi 2015; 23(2): 118-123.

De Palma GD, Galloro G, Siciliano S, et al. Unilateral versus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction: Results of a prospective, randomized, and controlled study. Gastrointest Endosc 2001; 53(6): 547-553.

Gamanagatti S, Singh T, Sharma R et al. Unilobar Versus Bilobar Biliary Drainage: Effect on Quality of Life and Bilirubin Level Reduction. Indian J Palliat Care 2016; 22(1): 50-62.

Moss AC, Morris E, Leyden J, et al. Do the benefits of metal stents justify the costs? A systematic review and meta-analysis of trials comparing endoscopic stents for malignant biliary obstruction. Eur J Gastroenterol Hepatol 2007; 19(12): 1119-1124.

Hong WD, Chen XW, Wu WZ, et al. Metal vs. plastic stents for malignant biliary obstruction: An update meta-analysis. Clin Res Hepatol Gastroenterol 2013; 37(5): 496-500.

Al Mahjoub A, Menahem B, Fohlen A, et al. Preoperative Biliary Drainage in Patients with Resectable Perihilar Cholangiocarcinoma: Is Percutaneous Transhepatic Biliary Drainage Safer and More Effective than Endoscopic Biliary Drainage? A Meta-Analysis. J Vasc Interv Radiol 2017; 28(4): 576-582.

Mohkam K, Malik Y, Derosas C, et al. Percutaneous transhepatic cholangiographic endobiliary forceps biopsy versus endoscopic ultrasound fine needle aspiration for proximal biliary strictures: A single-centre experience. HPB (Oxford) 2017; Mar 13. pii: S1365-182X(17)30066-7. doi: 10.1016/j.hpb.2017.02.001. [Epub ahead of print]

Huang SY, Philip A, Richter MD, et al. Prevention and management of infectious complications of percutaneous interventions. Semin Intervent Radiol 2015; 32(2): 78-88.

Venkatesan AM, Kundu S, Sacks D, et al. Practice guidelines for adult antibiotic prophylaxis during vascular and interventional radiology procedures. Written by the Standards of Practice Committee for the Society of Interventional Radiology and Endorsed by the Cardiovascular Interventional Radiological Society of Europe and Canadian Interventional Radiology Association. J Vasc Interv Radiol 2010; 21: 1611-1630.

Brody LA, Brown KT, Getrajdman GI, et al. Clinical factors associated with positive bile cultures during primary percutaneous biliary drainage. J Vasc Interv Radiol 1998; 9: 572-578.

Winick AB, Waybill PN, Venbrux AC. Complications of percutaneous transhepatic biliary interventions. Tech Vasc Interv Radiol 2001;4: 200-206.

Yarmohammadi H and Covey AM. Percutaneous biliary interventions and complications in malignant bile duct obstruction. Chin Clin Oncol 2016; 5(5): 68-78.

L’Hermine C, Ernst O, Delemazure O, et al. Arterial complications of percutaneous transhepatic biliary drainage. Cardiovasc Intervent Radiol 1996; 19(3): 160-164.

Rivera-Sanfeliz GM, Assar OS, LaBerge JM, et al. Incidence of important hemobilia following transhepatic biliary drainage: Left-sided vs. right-sided approaches. Cardiovasc Intervent Radiol 2004; 27(2): 137-139.

Choi SH, Gwon DI, Ko GY, et al. Hepatic Arterial Injuries in 3110 Patients Following Percutaneous Transhepatic Biliary Drainage. Radiology 2011; 261(3): 969-975.

Marynissen T, Maleux G, Heye S, et al. Transcatheter arterial embolization for iatrogenic hemobilia is a safe and effective procedure: Case series and review of the literature. Eur J Gastroenterol Hepatol 2012; 24: 905-909.

Tsai CC, Chiu KC, Mo LR, et al. Transcatheter arterial coil embolization of iatrogenic pseudoaneurysms after hepatobiliary and pancreatic interventions. Hepatogastroenterology 2007; 54(73): 41-46.

Dale AP, Khan R, Mathew A, et al. Hepatic tract embolization after biliary stenting. Is it worthwhile? Cardiovasc Intervent Radiol 2015; 38(5): 1244-1251.

Uller W, Mueller-Wille R, Grothues D, et al. Gelfoam for closure of large percutaneous transhepatic and transsplenic puncture tracts in pediatric patients. Rofo 2014; 186(7): 693-697.

Park SY, Kim J, Kim BW, et al. Embolization of percutaneous transhepatic portal venous access tract with N-butyl cyanoacrylate. Br J Radiol 2014; 87: 20140347.


Refbacks

  • There are currently no refbacks.