Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-669899f699-2mbcq Total loading time: 0 Render date: 2025-04-29T05:14:33.990Z Has data issue: false hasContentIssue false

31 - Extrahepatic Biliary Cancer/Biliary Drainage

from PART III - ORGAN-SPECIFIC CANCERS

Published online by Cambridge University Press:  18 May 2010

By
Tarun Sabharwal ,
Manpreet Singh Gulati  and
Andy Adam
Edited by
Jean-François H. Geschwind  and
Michael C. Soulen
Tarun Sabharwal
Affiliation:
Consultant Radiologist, Department of Radiology St. Thomas' Hospital London, UK
Manpreet Singh Gulati
Affiliation:
Consultant Radiologist Queen Elizabeth Hospital Honorary, Foundation Trust London, UK
Andy Adam
Affiliation:
Professor Department of Radiology, St. Thomas' Hospital London, UK
Jean-François H. Geschwind
Affiliation:
The Johns Hopkins University School of Medicine
Michael C. Soulen
Affiliation:
University of Pennsylvania School of Medicine
Get access

Summary

In the early 1970s, Molnar and Stockum introduced nonsurgical biliary intervention in the form of percutaneous transhepatic biliary drainage (PTBD) (1). Percutaneous transhepatic cholangiography (PTC) had been performed for several years prior to this, but therapeutic biliary interventions had been outside the radiologists' domain. In the past 30 years, improved diagnostic imaging techniques and significant developments in interventional radiology and experience gained by clinical trials have revolutionized and clearly defined the role of percutaneous biliary interventions.

The role of PTC has progressively diminished in the face of noninvasive imaging techniques such as ultrasonography (US), three-dimensional (3D) computer tomography and magnetic resonance cholangiography (MRC). Endoscopic retrograde cholangiography has further reduced its diagnostic role in the recent years. PTC is now reserved only for problematic cases and as an evaluation immediately prior to percutaneous intervention.

PTBD, which was initially proposed as a routine preoperative measure for those with severe obstructive jaundice, is now more of a palliative procedure in patients with inoperable malignant obstruction. This has been brought about by improved preoperative patient preparation, good antibiotic therapy, improved surgical techniques and easy availability of endoscopic biliary drainage expertise. One of the most important recent advances has been the introduction of self-expanding metallic stents for use in malignant obstructions.

In this chapter, we discuss all of the aforementioned percutaneous interventional radiological techniques, their indications and the other issues involved.

Type
Chapter
Information
Interventional Oncology
Principles and Practice
 , pp. 358 - 376
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Molnar, W and Stockum, A E. Transhepatic dilatation of choledochoenterostomy strictures. Radiology, 1978 Oct; 129(1): 59–64.CrossRefGoogle Scholar
Kumaran, V, Gulati, M S, Paul, S B, et al. The role of dual phase helical CT in assessing resectability of carcinoma of the gallbladder. Eur Radiol, 2002; 12: 1993–1999.CrossRefGoogle ScholarPubMed
Blumgart LH. Cholangiocarcinoma. In: Blumgart, L H (ed.), Surgery of the Liver and Biliary Tract, pp. 721–753. Edinburgh: Churchill Livingstone, 1998.Google Scholar
Pillai, VAK, Shreekumar, K P, Prabhu, N K, et al. Utility of MR cholangiography in planning transhepatic biliary interventions in malignant hilar obstructions. Indian J Radiol Imaging, 2002; 12: 37–42.Google Scholar
Speer, A G, Russel, C G and Hatfield, ARW. Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice. Lancet, 1987; 11: 57–62.CrossRefGoogle ScholarPubMed
Morgan RA and Adam A. Percutaneous management of biliary obstruction. In: Gazelle, G S, Saini, S, Mueller, P R (eds.): Hepatobiliary and Pancreatic Radiology Imaging and Intervention, pp. 677–709. Thieme: Verlag, 1998.Google Scholar
Kersjes, W, Koster, O, Heuer, M, et al. A comparison of imaging procedures in the diagnosis of gallbladder and bile duct carcinomas. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr, 1990; 153: 174–180.Google Scholar
Gulliver, D J, Baker, M E, Cheng, C A, et al. Malignant biliary obstruction: Efficacy of thin section dynamic CT in determining resectability. AJR Am J Roentgenol, 1992; 159: 503–507.CrossRefGoogle ScholarPubMed
Choi, B I, Lee, J H, Han, M C, et al. Hilar cholangio-carcinoma: Comparative study with sonography and CT. Radiology, 1989; 172: 689–692.CrossRefGoogle Scholar
Aretxabala, X, Roa, I, Burgos, L, et al. Gallbladder cancer in Chile. A report on 54 potentially resectable tumors. Cancer, 1992; 69: 60–65.3.0.CO;2-N>CrossRefGoogle ScholarPubMed
Cha, J H, Han, J K, Kim, T K, et al. Preoperative evaluation of Klatskin tumor: Accuracy of spiral CT in determining vascular invasion as a sign of unresectability. Abdom Imaging, 2000; 25: 500–507.CrossRefGoogle ScholarPubMed
Feydy, A, Vilgrain, V, Denys, A, et al. Helical CT assessment in hilar cholangiocarcinoma: Correlation with surgical and pathologic findings. AJR Am J Roentgenol, 1999; 172: 73–77.CrossRefGoogle ScholarPubMed
Beers, B E, Lacrosse, M, Trigaux, J P, et al. Noninvasive imaging of the biliary tree before or after laparoscopic cholecystectomy: Use of three dimensional spiral CT cholangiography. AJR Am J Roentgenol, 1994; 162: 1331–1335.CrossRefGoogle ScholarPubMed
Kwon, A H, Uetsuji, S, Yamada, O, et al. Three dimensional reconstruction of the biliary tract using spiral computed tomography. Br J Surg, 1995; 82: 260–263.CrossRefGoogle ScholarPubMed
Zeman, R K, Berman, P M, Silverman, P M, et al. Biliary tract: Three dimensional helical CT without cholangiographic contrast material. Radiology, 1995; 196: 865–867.CrossRefGoogle ScholarPubMed
Rao, NDLV, Gulati, M S, Paul, S B, et al. Three-dimensional helical CT cholangiography with minimum intensity projection in gallbladder carcinoma patients with obstructive jaundice: Comparison with magnetic resonance cholangiography and percutaneous transhepatic cholangiography. J Gastroenterol Hepatol, 2005; 20: 304–308.CrossRefGoogle ScholarPubMed
Park, S J, Han, J K, Kim, T K, et al. Three-dimensional spiral CT cholangiography with minimum intensity projection in patients with suspected obstructive biliary disease: Comparison with percutaneous transhepatic cholangiography. Abdom Imaging, 2001; 26(3): 281–286.CrossRefGoogle ScholarPubMed
Adamck, H E, Albert, J, Lietz, M, et al. A prospective evaluation of magnetic resonance cholangiography in patients with suspected bile duct obstruction. Gut, 1998; 43: 680–683.CrossRefGoogle Scholar
Lopera, J E, Soto, J A, and Múnera, F. Malignant hilar and perihilar biliary obstruction: Use of MR cholangiography to define the extent of biliary ductal involvement and plan percutaneous interventions. Radiology, 2001; 220: 90–96.CrossRefGoogle ScholarPubMed
Bismuth, H and Corlette, M B. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet, 1975; 140: 170–178.Google ScholarPubMed
Polydorou, A A, Chisholm, E M, Romanos, A A, et al. A comparison of right versus left hepatic duct endoprosthesis insertion in malignant hilar biliary obstruction. Endoscopy, 1989; 21: 266–271.CrossRefGoogle ScholarPubMed
Chang, W H, Kortan, P, and Haber, G B. Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage. Gastrointest Endosc, 1998; 47: 354–362.CrossRefGoogle ScholarPubMed
Lee, K H, Lee, D Y, and Kim, K W. Biliary intervention for cholangiocarcinoma. Abdom Imaging, 2004; 29: 581–589.CrossRefGoogle ScholarPubMed
Cope, C. Conversion from small (0.018 inch) to large (0.038 inch) guide wires in percutaneous drainage procedures. Am J Roentgenol, 1982; 138: 170–171.CrossRefGoogle ScholarPubMed
Morgan, R A and Adam, A. Metallic stents in the treatment of patients with malignant biliary obstruction. Semin Intervent Radiol, 1996; 13: 229–240.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
Davids, PHP, Groen, A K, Rauws, EAJ, et al. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet, 1992; 340: 1488–1492.CrossRefGoogle ScholarPubMed
Knyrim, K, Wagner, H-J, Pausch, J, et al. A prospective, randomised controlled trial of metal stents for malignant obstruction of the common bile duct. Endoscopy, 1993; 25: 207–212.CrossRefGoogle ScholarPubMed
Lammer, J, Hausegger, K A, Fluckiger, F, et al. Common bile duct obstruction due to malignancy: Treatment with plastic versus metal stents. Radiology, 1996; 201: 167–172.CrossRefGoogle ScholarPubMed
Adam, A, Roddie, M E, Jackson, J E, et al. Wallstent endoprostheses for biliary malignancy: What is the verdict after 7 years use?Radiology, 1994; 193(P): 327.Google Scholar
Shim, C S, Lee, J H, Cho, J D, et al. Preliminary results of a new covered biliary metal stent for malignant biliary obstruction. Endoscopy, 1998; 30: 345–350.CrossRefGoogle ScholarPubMed
Rossi, P, Bezzi, M, Salvatori, F M, et al. Clinical experience with covered Wallstents for biliary malignancies: 23-month follow-up. Cardiovasc Intervent Radiol, 1997; 20: 441–447.CrossRefGoogle ScholarPubMed
Hausegger, K A, Thurnher, S, Bodendorfer, G, et al. Treatment of malignant biliary obstruction with polyurethane-covered Wallstents. Am J Roentgenol Am J Roentgenol, 1998; 170: 403–408.CrossRefGoogle ScholarPubMed
Bezzi, M, Zolovkins, A, Cantisani, V, et al. New ePTFE/FEP-covered stent in the palliative treatment of malignant biliary obstruction. J Vasc Interv Radiol, 2002; 13: 581–589.CrossRefGoogle ScholarPubMed
Schoder, M, Rossi, P, Uflacker, R, et al. Malignant biliary obstruction: Treatment with ePTFE-FEP – covered endoprostheses – initial technical and clinical experiences in a multicenter trial. Radiology, 2002; 225: 35–42.CrossRefGoogle Scholar
Nicholson, D A, Cheety, N, and Jackson, J. Patency of side branches after peripheral placement of metallic biliary endoprosthesis. J Vasc Interv Radiol, 1992; 3: 127–130.CrossRefGoogle Scholar
Wayman, J, Mansfield, J C, Mathewson, K, et al. Combined percutaneous and endoscopic procedures for bile duct obstruction: Simultaneous and delayed techniques compared. Hepatogastroenterology, 2003; 50: 915–918.Google ScholarPubMed
Ferrucci, J T Jr, Mueller, P R, and Harbim, W P. Percutaneous transhepatic biliary drainage: Technique, results and applications. Radiology, 1980; 135: 1–13.CrossRefGoogle ScholarPubMed
Hamlin, J A, Friedman, M, Stein, M G, et al. Percutaneous biliary drainage: Complications of 118 consecutive catheterizations. Radiology, 1986; 158: 199–202.CrossRefGoogle ScholarPubMed
Lamaris, J S, Stoker, J, Dees, J, et al. Nonsurgical palliative treatment of patients with malignant biliary obstruction – the place of endoscopic and percutaneous drainage. Clin Radiol, 1987; 38: 603–608.CrossRefGoogle Scholar
Clark, R A, Mitchell, S E, Colley, D P, et al. Percutaneous catheter biliary decompression. Am J Roentgenol, 1981; 137: 503–509.CrossRefGoogle ScholarPubMed
Yee, A C, Ho, C S. Complications of transhepatic biliary drainage: Benign vs malignant diseases. Am J Roentgenol, 1987; 148: 1207–1209.CrossRefGoogle ScholarPubMed
Carrasco, C H, Zornoza, J, and Bechtel, W J. Malignant biliary obstruction: Complications of percutaneous biliary drainage. Radiology, 1984; 152: 343–346.CrossRefGoogle ScholarPubMed
Berquist, T H, May, G R, Johnson, C M, et al. Percutaneous biliary decompression: Internal and external drainage in 50 patients. Am J Roentgenol, 1981; 136: 901–906.CrossRefGoogle ScholarPubMed
Mueller, P R, Sonnenberg, E, Ferrucci, J T Jr. Percutaneous biliary drainage: Technical and catheter related problems in 200 procedures. Am J Roentgenol, 1982; 138: 17–23.CrossRefGoogle ScholarPubMed
Rosenblatt M, Aruny JE, and Kandarpa K. Transhepatic cholangiography, biliary decompression, endobiliary stenting, and cholecystostomy. In: Kandarpa, K, Aruny, J E (eds), Handbook of Interventional Radiology Procedures, pp. 302–331. Philadelphia: Lippincott Williams & Wilkins, 2002.Google Scholar
Strange, C, Allen, M L, Freedland, P N, et al. Biliopleural fistula as a complication of percutaneous biliary drainage: Experimental evidence for pleural inflammation. Am Rev Respir Dis, 1988; 137: 959–961.CrossRefGoogle ScholarPubMed
Dawson, S L, Neff, C C, Mueller, P R, et al. Fatal hemo-thorax after inadvertent transpleural biliary drainage. Am J Roentgenol, 1983; 141: 33–34.CrossRefGoogle Scholar
Gazzaniga, G M, Faggioni, A, Bondanza, G, et al. Percutaneous transhepatic biliary drainage – twelve years experience. Hepatogastroenterology, 1991; 38: 154–159.Google Scholar
Sheiman, R G and Stuart, K. Percutaneous cystic duct stent placement for the treatment of acute cholecystitis resulting from common bile duct stent placement for malignant obstruction. J Vasc Interv Radiol, 2004; 15: 999–1001.CrossRefGoogle ScholarPubMed
Cutherell, L, Wanebo, H J, Tegtmeyer, C J. Catheter tract seeding after percutaneous biliary drainage for pancreatic cancer. Cancer, 1986; 57: 2057–2060.3.0.CO;2-3>CrossRefGoogle ScholarPubMed
Wittich, G R, Sonnertberg, E, Simeone, J F. Results and complications of percutaneous drainage. Semin Interv Radiol, 1985; 2: 39–49.CrossRefGoogle Scholar
Pereiras, R V Jr, Rheingold, O J, Huston, D, et al. Relief of malignant obstructive jaundice by percutaneous insertion of a permanent prosthesis. Ann Intern Med, 1978; 89: 589–593.CrossRefGoogle ScholarPubMed
Voegeli, D R, Crummy, A B, and Weese, J L. Percutaneous transhepatic cholangiography, drainage and biopsy in patients with malignant biliary obstruction. An alternative to surgery. Am J Surg, 1985; 150: 243–247.CrossRefGoogle Scholar
Joseph, P K, Bizer, L S, Sprayregan, S S, et al. Percutaneous transhepatic biliary drainage. Results and complications in 81 patients. JAMA, 1986; 255: 2763–2767.CrossRefGoogle ScholarPubMed
Lammer, J, Neumayer, K, and Steiner, H K. Biliary drainage endoprosthesis: Experience with 201 patients. Radiology, 1986; 159: 625–629.CrossRefGoogle Scholar
Schild, H, Klose, K J, Staritz, M, et al. The results and complications of 616 percutaneous transhepatic biliary drainages. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr, 1989 Sep; 151(3): 289–293.CrossRefGoogle Scholar
Murai, R, Hashiguchi, F, Kusuyama, A, et al. Percutaneous stenting for malignant biliary stenosis. Surg Endosc, 1991; 5: 140–142.CrossRefGoogle ScholarPubMed
Rieber, A and Brambs, H J. Metallic stents in malignant biliary obstruction. Cardiovasc Intervent Radiol, 1997; 20: 43–49.CrossRefGoogle ScholarPubMed
Cowling, M G and Adam, A N. Internal stenting in malignant biliary obstruction. World J Surg, 2001; 25: 355–361.CrossRefGoogle ScholarPubMed
Deviere, J, Baize, M, Toeuf, J, et al. Long-term follow-up of patients with hilar malignant stricture treated by endoscopic internal biliary drainage. Gastrointest Endosc, 1988; 34: 95–101.CrossRefGoogle ScholarPubMed
Motte, S, Deviere, J, Dumonceau, J M, et al. Risk factors for septicemia following endoscopic biliary stent. Gastroenterology, 1991; 101: 1374–1381.CrossRefGoogle Scholar
Davids, P H, Groen, A K, Rauws, E A, et al. Randomised trial of self expanding metallic stents versus polyethylene stents for distal malignant biliary obstruction. Lancet, 1992; 340: 1488–1492.CrossRefGoogle Scholar
Knyrim, K, Wagner, H J, Pausch, J, et al. A prospective, randomized, controlled trial of metal stents for malignant obstruction of the common bile duct. Endoscopy, 1993 Mar; 25(3): 207–212.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×