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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
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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

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