Transnasal removal of a biliary endoprosthesis with percutaneous transhepatic biliary catheter replacement

The authors describe a novel fluoroscopically guided transnasal technique for removal of an endoscopically placed endobiliary prosthesis (EBP). A case in which the approach was applied is used to demonstrate its indications, clinical utility and possible benefits. The procedure entails simultaneous percutaneous replacement of the EBP with an internal/external biliary catheter over a through-and-through transhepatic/transnasal access wire. A comparison of the technique's limitations with those of traditional approaches for endoscopic or percutaneous EBP removal and replacement is presented.