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Biliäre Interventionen

Perkutane transhepatische Cholangiodrainage bis Biliom

Biliary system interventions

Percutaneous transhepatic cholangiodrainage to bilioma

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Zusammenfassung

Hintergrund

Eine Vielzahl von transhepatischen perkutanen biliären Eingriffen ist für die Behandlung von Pathologien des biliären Systems geeignet.

Fragestellung

Aufzeigen bewährter Vorgehensweise bei der Durchführung der perkutanen transhepatischen Cholangiographie mit Anlage einer biliären Drainage (PTCD), der perkutanen transhepatischen Entfernung von Gallengangsteinen, der perkutanen Stentbehandlung der Gallenwege sowie der perkutanen Behandlung postoperativer Biliome.

Material und Methode

Die Autoren sichteten die vorhandene Literatur zu den relevanten aktuellen Empfehlungen und stellen diese anhand der gängigen Vorgehensweise in der eigenen Einrichtung vor.

Ergebnisse

Die Interventionen an den Gallenwegen zielen zumeist auf die Behandlung der Cholestase benigner oder maligner Genese ab. Die technische Erfolgsrate liegt bei bis zu 90 %.

Schlussfolgerungen

Perkutane Gallenweginterventionen sind sichere und effektive Verfahren in der Behandlung von Pathologien des biliären Systems, welche nicht nur, aber bevorzugt zum Einsatz kommen, wenn der endoskopische Zugang aufgrund von anatomischen Gegebenheiten nicht gelingt.

Abstract

Background

A variety of transhepatic percutaneous biliary procedures are appropriate for the treatment of pathologies of the biliary system.

Objectives

The aim of this article is to describe best practices for performing percutaneous transhepatic cholangiography with placement of a biliary drain (PTCD), percutaneous transhepatic removal of bile duct stones, percutaneous stenting of the bile ducts, and percutaneous treatment of postoperative bilioma.

Materials and methods

The authors reviewed existing literature on relevant current recommendations and presented them based on their own facility’s approach.

Results

Biliary interventions are mostly aimed at treating some form of cholestasis of benign or malignant etiology. The technical success rate is up to 90%.

Conclusion

Percutaneous biliary interventions are safe and effective procedures in the treatment of pathologies of the biliary system, preferably used when endoscopic access is not possible due to anatomical conditions.

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Literatur

  1. Ahmed O, Mathevosian S, Arslan B (2016) Biliary interventions: tools and techniques of the trade, access, cholangiography, biopsy, cholangioscopy, cholangioplasty, stenting, stone extraction, and brachytherapy. Semin intervent Radiol 33(4):283–290

    Article  Google Scholar 

  2. Aung TH, Too CW, Kumar N, Damodharan K, Urlings TA, Patel A, Chan S, Toh L, Gogna A, Irani F et al (2016) Severe bleeding after percutaneous transhepatic drainage of the biliary system. Radiology 278:957–958

    Article  Google Scholar 

  3. Castiglione D, Gozzo C, Mammino L, Failla G, Palmucci S, Basile A (2020) Health-Related Quality of Life evaluation in “left” versus “right” access for percutaneous transhepatic biliary drainage using EORTC QLQBIL-21 questionnaire: a randomized controlled trial. Abdom Radiol 45(4):1162–1167

    Article  Google Scholar 

  4. Chehab MA, Thakor AS, Tulin-Silver S, Connolly BL, Cahill AM, Ward TJ, Padia SA, Kohi MP, Midia M, Chaudry G, Gemmete JJ, Mitchell JW, Brody L, Crowley JJ, Heran MKS, Weinstein JL, Nikolic B, Dariushnia SR, Tam AL, Venkatesan AM (2018) Adult and pediatric antibiotic prophylaxis during vascular and IR procedures: a society of Interventional radiology practice parameter update endorsed by the cardiovascular and Interventional radiological society of europe and the Canadian association for Interventional radiology. J Vasc Interv Radiol 29(11):1483–1501

    Article  Google Scholar 

  5. Das M, van der Leij C, Katoh M, Benten D, Hendriks BMF, Hatzidakis A (2021) CIRSE standards of practice on percutaneous transhepatic cholangiography, biliary drainage and stenting. Cardiovasc Intervent Radiol 44(10):1499–1509

    Article  Google Scholar 

  6. Fidelman N, Bloom AI, Kerlan RK Jr., Laberge JM, Wilson MW, Ring EJ, Gordon RL (2008) Hepatic arterial injuries after percutaneous biliary interventions in the era of laparoscopic surgery and liver transplantation: experience with 930 patients. Radiology 247:880–886

    Article  Google Scholar 

  7. García-García L, Lanciego C (2004) Percutaneous treatment of biliary stones: sphincteroplasty and occlusion balloon for the clearance of bile duct calculi. AJR Am J Roentgenol 182(3):663–670

    Article  Google Scholar 

  8. Gil S, de la Iglesia P, Verdú JF, de España F, Arenas J, Irurzun J (2000) Effectiveness and safety of balloon dilation of the papilla and the use of an occlusion balloon for clearance of bile duct calculi. AJR Am J Roentgenol 174(5):1455–1460

    Article  CAS  Google Scholar 

  9. Huang X, Shen L, Jin Y et al (2015) Comparison of uncovered stent placement across versus above the main duodenal papilla for malignant biliary obstruction. J Vasc Interv Radiol 26(3):432–437

    Article  Google Scholar 

  10. Khardori N, Wong E, Carrasco CH, Wallace S, Patt Y, Bodey GP (1991) Infections associated with biliary drainage procedures in patients with cancer. Rev Infect Dis 13(4):587–591

    Article  CAS  Google Scholar 

  11. Kubo N, Shirabe K (2020) Treatment strategy for isolated bile leakage after hepatectomy: literature review. Ann Gastroenterol Surg 4(1):47–55

    Article  Google Scholar 

  12. Kurniawan J, Hasan I, Gani RA, Simadibrata M (2016) Mortality-related factors in patients with malignant obstructive jaundice. Acta Med Indones 48(4):282–288

    Google Scholar 

  13. Lanciego Pérez C, García-García L (2009) Interventional radiology for bile duct stones. Radiologia 51:559–567

    Article  Google Scholar 

  14. Madhusudhan KS, Gamanagatti S, Gupta AK (2015) Imaging and interventions in hilar cholangiocarcinoma: a review. World J Radiol 7(2):28–44

    Article  Google Scholar 

  15. Morita S, Kitanosono T, Lee D et al (2012) Comparison of technical success and complications of percutaneous transhepatic cholangiography and biliary drainage between patients with and without transplanted liver. AJR Am J Roentgenol 199(5):1149–1152

    Article  Google Scholar 

  16. Nichols DM, Cooperberg PL, Golding RH, Burhenne HJ (1984) The safe intercostal approach? Pleural complications in abdominal interventional radiology. AJR Am J Roentgenol 142(5):1013–1018

    Article  CAS  Google Scholar 

  17. Park YS, Kim JH, Choi YW et al (2005) Percutaneous treatment of extrahepatic bile duct stones assisted by balloon sphincteroplasty and occlusion balloon. Korean J Radiol 6(4):235–240

    Article  Google Scholar 

  18. Ring EJ, Kerlan RK Jr. (1984) Interventional biliary radiology. AJR Am J Roentgenol 142(1):31–34

    Article  CAS  Google Scholar 

  19. Ryu JK (2013) Percutaneous approach for removal of difficult common bile duct stones. Clin Endosc 46(1):3–4

    Article  Google Scholar 

  20. Saad WE, 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(6):789–795

    Article  Google Scholar 

  21. Tsuyuguchi T, Takada T, Miyazaki M, Miyakawa S, Tsukada K, Nagino M, Kondo S, Furuse J, Saito H, Suyama M, Kimura F, Yoshitomi H, Nozawa S, Yoshida M, Wada K, Amano H, Miura F, Japanese Association of Biliary Surgery, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Japan Society of Clinical Oncology (2008) Stenting and interventional radiology for obstructive jaundice in patients with unresectable biliary tract carcinomas. J Hepatobiliary Pancreat Surg 15(1):69–73

    Article  Google Scholar 

  22. Turan AS, Jenniskens S, Martens JM, et al (2022) Complications of percutaneous transhepatic cholangiography and biliary drainage, a multicenter observational study. Abdominal Radiology (New York) 47(9):3338–3344

  23. Venkatanarasimha N, Damodharan K, Gogna A, Leong S, Too CW, Patel A, Tay KH, Tan BS, Lo R, Irani F (2017) Diagnosis and management of complications from percutaneous biliary tract interventions. Radiographics 37:665–680

    Article  Google Scholar 

  24. Williams EJ, Green J, Beckingham I, Parks R, Martin D, Lombard M (2008) Guidelines on the management of common bile duct stones (CBDS). Gut 57:1004–1021

    Article  CAS  Google Scholar 

  25. Xing D, Song W, Gong S, Xu A, Zhai B (2022) Analysis of the bacterial spectrum and key clinical factors of biliary tract infection in patients with malignant obstructive jaundice after PTCD. Dis Markers 30(2022):1026254

    Google Scholar 

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Authors and Affiliations

  1. Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland

    Tatjana Dell &  Carsten Meyer

Authors
  1. Tatjana Dell
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  2. Carsten Meyer
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Correspondence to Tatjana Dell or Carsten Meyer.

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Interessenkonflikt

T. Dell und C. Meyer geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Dell, T., Meyer, C. Biliäre Interventionen. Radiologie 63, 30–37 (2023). https://doi.org/10.1007/s00117-022-01083-7

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  • DOI: https://doi.org/10.1007/s00117-022-01083-7

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