Combined percutaneous transhepatic biliary drainage with port implantation for management of patients with malignant biliary obstruction.

BACKGROUND

Endoscopic biliary stent insertion has become a standard palliative treatment for patients with obstructive jaundice caused by malignancies of the hepatobiliary system or metastases of other tumors, such as pancreatic or gastric cancer. Unfortunately, bacterial colonization and encrustation frequently leads to occlusion of plastic stents and, consequently, recurrent cholangitis.

METHODS

An external-internal Yamakawa-type endoprosthesis was modified and combined with a titanium, subcutaneously implanted port. This technique was evaluated as a new approach to prolongation of stent patency and prevention of cholangitis. Two patients with obstructive jaundice, one with recurrent gastric carcinoma and the other with invasive gallbladder cancer, underwent treatment with this new method.

RESULTS

Effective biliary drainage was established and cholangitis was prevented in both patients for 6 and 2 months, respectively.

CONCLUSIONS

A new method of percutaneous transhepatic drainage combined with port implantation was effective and safe in two patients. This technique may be a reasonable treatment option for selected patients, but further evaluation in a larger series is required to establish efficacy and safety.