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CardioVascular and Interventional Radiology

, Volume 36, Issue 2, pp 521–525 | Cite as

Transjugular Insertion of Bare-Metal Biliary Stent for the Treatment of Distal Malignant Obstructive Jaundice Complicated by Coagulopathy

  • Jiaywei Tsauo
  • Xiao LiEmail author
  • Hongcui Li
  • Bo Wei
  • Xuefeng Luo
  • Chunle Zhang
  • Chengwei Tang
  • Weiping Wang
Technical Note
  • 336 Downloads

Abstract

Purpose

This study was designed to investigate retrospectively the feasibility of transjugular insertion of biliary stent (TIBS) for the treatment of distal malignant obstructive jaundice complicated by coagulopathy.

Methods

Between April 2005 and May 2010, six patients with distal malignant obstructive jaundice associated with coagulopathy that was unable to be corrected underwent TIBS at our institution for the palliation of jaundice. Patients’ medical record and imaging results were reviewed to obtain information about demographics, procedure details, complications, and clinical outcomes.

Results

The intrahepatic biliary tract was successfully accessed in all six patients via transjugular approach. The procedure was technically successfully in five of six patients, with a bare-metal stent implanted after traversing the biliary strictures. One procedure failed, because the guidewire could not traverse the biliary occlusion. One week after TIBS, the mean serum bilirubin in the five successful cases had decreased from 313 μmol/L (range 203.4–369.3) to 146.2 μmol/L (range 95.8–223.3) and had further decreased to 103.6 μmol/L (range 29.5–240.9) at 1 month after the procedure. No bleeding, sepsis, or other major complications were observed after the procedure. The mean survival of these five patients was 4.5 months (range 1.9–5.8). On imaging follow-up, there was no evidence of stent stenosis or migration, with 100 % primary patency.

Conclusions

When the risks of hemorrhage from percutaneous transhepatic cholangiodrainage are high, TIBS may be an effective alternative for the treatment of distal malignant obstructive jaundice.

Keywords

Non-vascular interventions Venous intervention Bile duct/gallbladder/biliary 

Notes

Acknowledgment

We thank Chinese Interventional Radiology Club (CIR Club) for the manuscript preparation. This paper is supported by the Natural Science Fund of China (Grant No. 30770984 and 81171444).

Conflict of interests

The authors declare that they have no conflict of interests.

References

  1. 1.
    Abraham NS, Barkun JS, Barkun AN (2002) Palliation of malignant biliary obstruction: a prospective trial examining impact on quality of life. Gastrointest Endosc 56(6):835–841PubMedCrossRefGoogle Scholar
  2. 2.
    Garcea G, Ong S, Dennison A, Berry D, Maddern GJ (2009) Palliation of malignant obstructive jaundice. Dig Dis Sci 54(6):1184–1198PubMedCrossRefGoogle Scholar
  3. 3.
    van Delden OM, Lameris JS (2008) Percutaneous drainage and stenting for palliation of malignant bile duct obstruction. Eur Radiol 18(3):448–456PubMedCrossRefGoogle Scholar
  4. 4.
    Speer AG, Christopher R, Russell G, Hatfield AR (1987) Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice. Lancet 330(8550):57–62CrossRefGoogle Scholar
  5. 5.
    Saad WEA, Wallace MJ, Wojak JC, Kundu S, Cardella JF (2010) Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy. J Vasc Interv Radiol 21:789–795PubMedCrossRefGoogle Scholar
  6. 6.
    Ring E, Gordon R, LaBerge J, Shapiro H (1991) Malignant biliary obstruction complicated by ascites: transjugular insertion of an expandable metallic endoprosthesis. Radiology 180(2):579–581PubMedGoogle Scholar
  7. 7.
    Amygdalos MA, Haskal ZJ, Cope C, Kadish SL, Long WB (1996) Transjugular insertion of biliary stents (TIBS) in two patients with malignant obstruction, ascites, and coagulopathy. Cardiovasc Intervent Radiol 19(2):107–109PubMedCrossRefGoogle Scholar
  8. 8.
    Hanafee WN, Rösch J, Weiner M (1970) Transjugular dilatation of the biliary duct system. Radiology 94(2):429–432PubMedGoogle Scholar
  9. 9.
    Papadopoulos V, Filippou D, Manolis E, Mimidis K (2007) Haemostasis impairment in patients with obstructive jaundice. J Gastrointest Liver Dis 16(2):177–186Google Scholar
  10. 10.
    Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD (2009) Liver biopsy. Hepatology 49(3):1017–1044PubMedCrossRefGoogle Scholar
  11. 11.
    Hatzidakis AA (2011) Percutaneous biliary drainage and stenting. In: Gervais DA, Sabharwal T (eds) Interventional radiology procedures in biopsy and drainage. Springer, London, pp 143–153Google Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2012

Authors and Affiliations

  • Jiaywei Tsauo
    • 1
  • Xiao Li
    • 1
    Email author
  • Hongcui Li
    • 1
  • Bo Wei
    • 1
  • Xuefeng Luo
    • 1
  • Chunle Zhang
    • 1
  • Chengwei Tang
    • 1
  • Weiping Wang
    • 2
  1. 1.Department of Gastroenterology and HepatologyWest China Hospital of Sichuan UniversityChengduPeople’s Republic of China
  2. 2.Section of Interventional Radiology, Cleveland Clinic, Imaging InstituteClevelandUSA

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