Direct Puncture of Preexisting Endoscopic Stents for Percutaneous Transhepatic Biliary Drainage: Technical Feasibility and Safety.

Percutaneous transhepatic biliary drainage (PTBD) is an alternative approach for biliary drainage in patients for whom endoscopic retrograde biliary drainage is not available due to surgically altered anatomy or poor clinical status; however, it remains technically challenging with nondilated bile ducts. This retrospective study evaluated the technical feasibility and safety of puncture of preexisting endoscopic biliary stents to opacify the biliary system and facilitate PTBD. Seventeen procedures in 15 patients with nondilated bile ducts were included. Technical success, adverse events, procedural details, and subsequent stent management were assessed. All procedures were technically successful. No severe adverse events occurred, and stent puncture was not associated with stent damage or difficulty in subsequent stent management. Reintervention was required in 3 cases. Despite the retrospective design and small sample size, these findings suggest direct puncture of preexisting endoscopic stents is a safe and feasible option for PTBD in patients with nondilated bile ducts.