Percutaneous Endoscopic Biliary Stenting

Abstract

Background/Aims : In malignant biliary obstruction, percutaneous endoscopic biliary

stenting (PEBS) has been performed as a combined percutaneous-endoscopic method for

conversion of percutaneous biliary drainage (PBD) into endoscopic biliary drainage

(EBD). The aim of this study was to assess the clinical significance of PEBS.

Methods : The PEBS was performed to insert biliary stents in 20 cases for 18

patients (mean age 65.7 years, 10 males and 8 females) with unresectable malignant

biliary obstruction (gallbladder cancer 5, pancreas cancer 2, Klatskin tumor 8, common

bile duct cancer 1, ampullary cancer 1, icteric hepatoma 1) A guidewire was advanced

into the duodenum through a percutaneous route of PBD, trapped with a basket, and

pulled out through the working channel of a duodenoscope. Based on this guidewire, the

EBD was performed.

Results : The reasons for performing the initial PBD were debilitated conditions such

as sepsis in 7 cases and a failure of initial EBD in 13 cases (failure of selective

cannulation of bile duct in 2, failure of guidewire insertion through the stenotic lesion in

3, and failure of guidewire insertion into the intrahepatic bile duct to be drained in 8).

The biliary stents (a single plastic steno in 8, double plastic stents in 10, a single

metallic stunt in 2) were successfully inserted through the percutaneous route (PTBD in

19, T-tube in 1) with the PEBS method. No complications such as choleperitonitis,

hemobilia, migration of stents, cholecystitis, or pancreatitis were observed.

Conclusions : PEBS is an easy and useful drainage method for conversion of PBD

into EBD in unresectable malignant obstruction, when initial EBD is inappropriate.