Interventional therapy using percutaneous transhepatic route for biliary diseases

• Published in: Tando Vol. 20; no. 4; pp. 499 - 507
• Main Author: SAITO, Hiroya
• Format: Journal Article
• Language: Japanese
• Published: Japan Biliary Association 2006
• Subjects: biliary sten; magnetic compression anastomosis; metallic stent; portal stent; PTBD; メタリックステント; 磁石圧迫吻合術; 胆管ステント; 門脈ステント
• ISSN: 0914-0077; 1883-6879
• DOI: 10.11210/tando1987.20.4_499

Interventional therapy using percutaneous transhepatic route is playing a significant role in treatment for biliary benign or malignant diseases. Regarding percutaneous intervension of biliary obstruction resulting from hilar malignancy can be accomplished in a variety of ways. Bilateral percutaneous transhepatic biliary drainage has been performed with placement of multiple stents with unilateral or bilateral transhepatic approaches. And I evaluated the technical and clinical efficacy of placement of multiple stents in a T-configuration for the management of malignant hilar obstructions to achieve bilateral internal drainage of the right and left ductal systems by means of a percutaneous transhepatic approach. Concerning portal stenosis, it can lead to the development of hortal hypertension, with potentially serious consequences. For the treatment of such patients, an expandable metallic stent is placed into the portal vein, and have obtained favorable therapeutic results. Stent placement relieved the narrowing of the portal vein, leading to an immediate decrease of portal pressure and hemostasis with massive gastrointestinal bleeding. The concept of magnetic compression anastomosis is that two magnets are attracted transmurally between two internal organs with the subsequent compression resulting in fistula formation. A parent magnet was placed endoscopically into the gastrointestinal system and the daughter magnet attached to a guide wire was placed in the obstructed common bile duct through a percutaneous transhepatic drainage tube. Two magnets are immediately attracted towards each other transmurally, and anastomosis is established usually within seven to 14 days after procedure. This novel method of magnetic compression anastomosis has the advantages of noninvasiveness and simplicity, as well as being a well-tolerated procedure for indications such as biliary obstruction. Even now, Interventional therapy using percutaneous transhepatic route for biliary diseases is an essential procedure in dealing with some disorders in the biliary diseases.