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Percutaneous Fluoroscopic-Guided Creation of Neoanastomosis for the Treatment of Biliary Occlusions

  • Clinical Investigation
  • Biliary
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

Complete biliary occlusions at different anatomic locations that are not amenable to surgical, endoscopic, or routine percutaneous methods pose a challenge to physicians. Biliary ductal neoanastomosis technique can play a very important role in solving such clinical problems.

Materials

Between October 2004 and January 2018, six patients were treated in our institution for biliary drainage using biliary ductal neoanastomosis technique via sharp recanalization and a staged approach to achieve internal/external biliary drainage. All procedures were performed in an angiography suite by an interventional radiologist after multidisciplinary discussion.

Results

The mean patient age of the cohort was 54 years and 50% of the patients were female (three/six patients). The cause of obstruction was complications or disease progression after  Whipple procedure in four patients, partial hepatectomy in one patient and benign biliary stricture after radioembolization in one patient. All patients were treated with percutaneous biliary neoanastomosis. All procedures were successfully performed in all six patients (100% technical success) without any major complications. All patients were successfully managed by capped drainage catheters for the duration of the follow up (one patient was transitioned to endoscopically inserted biliary stent, and in one patient the tube was eventually removed after establishment of patent neoanastomosis).

Conclusions

Biliary ductal neoanastomosis is an effective treatment option when the anatomy has been significantly altered in the post-surgical setting and wire cannot be safely passed into target draining organ or the remainder of biliary system. When performed by an experienced operator, this technique is safe and effective with a high technical success rate.

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Authors and Affiliations

  1. Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Peiman Habibollahi, Jamaal L. Benjamin, Harrison X. Bai, Mandeep S. Dagli & Richard D. Shlansky-Goldberg

  2. Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Peiman Habibollahi

  3. Department of Diagnostic Imaging, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, RI, USA

    Harrison X. Bai

Authors
  1. Peiman Habibollahi
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  2. Jamaal L. Benjamin
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  3. Harrison X. Bai
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  4. Mandeep S. Dagli
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  5. Richard D. Shlansky-Goldberg
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Correspondence to Richard D. Shlansky-Goldberg.

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Institutional review board approval for anonymous retrospective review of patients and informed consent is not required at our institution.

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Habibollahi, P., Benjamin, J.L., X. Bai, H. et al. Percutaneous Fluoroscopic-Guided Creation of Neoanastomosis for the Treatment of Biliary Occlusions. Cardiovasc Intervent Radiol 43, 1671–1678 (2020). https://doi.org/10.1007/s00270-020-02544-z

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  • DOI: https://doi.org/10.1007/s00270-020-02544-z

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