Abstract
Bile duct strictures may occur as a postoperative complication caused by cholangitis and liver dysfunction due to cholestasis. Postoperative bile stricture has been reported to be related to the patients’prognosis. In addition to surgical biliary drainage performed from time immemorial, percutaneous trans-hepatic drainage (PTBD) has also been performed. In recent years, endoscopic biliary drainage is becoming the procedure of first choice for the diagnosis and treatment of bile duct strictures. However, in some cases in who’s not only takes the reconstruction of the digestive tract, but also other major or minor operation induced the adhesion or the status of vagotomy. The method of endoscopic biliary drainage (EBD) is difficult and may also prove dangerous. Since the 1990s, the combined percutaneous and endoscopic approach (CPE) for internal biliary drainage has been used in cases with unsuccessful drainage following the use of either approach alone. Because this method requires proficiency in both the endoscopic and percutaneous techniques, it is difficult to establish as the procedure of first choice for biliary drainage, but it is extremely useful as a last resort for difficult-to-treat cases even after laparotomic open surgery. In this paper, we describe the historical evolution of these procedures, and outline the specific methods and the required technique of CPE.
