Procedures for Difficult Endoscopic Biliary Stenting

Abstract

Endoscopic biliary drainage has been recommended for treatment of jaundice and acute cholangitis associated with pancreatic head tumors in the Tokyo Guidelines 2013. We investigated the procedures used for difficult endoscopic biliary stenting. From April 2012 to August 2013, 274 patients underwent endoscopic biliary stenting, with 5 patients (1.8%) showing difficulty in the stenting. These comprised 3 patients with difficult biliary cannulation and 2 patients with duodenal stenosis. All these patients underwent percutaneous transhepatic biliary drainage (PTBD), performed with the internal PTBD tube fistula. One in 3 patients with difficult biliary cannulation was treated with endoscopic biliary stenting using the rendezvous technique after PTBD. Two patients with duodenal stenosis were treated with duodenal stenting followed by endoscopic biliary stenting. No complications were seen in any of the patients. The gold standard for biliary obstruction caused by pancreatic head tumors is endoscopic biliary drainage, but difficult cases exist. In cases of difficult biliary stenting, it is important to use the technique of interventional radiology.