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Updated: Aug 14, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Long-term outcome of percutaneous transhepatic drainage for benign bile duct stenoses
A Eickhoff1, D Schilling, R Jakobs
1Medical Department C, Gastroenterology, Hepatology and Oncology, Klinikum Ludwigshafen, Academic Hospital of the University of Mainz, Germany. eickhofa@klilu.de
Insights
Percutaneous transhepatic stenting effectively treats benign bile duct strictures, offering a safe alternative to surgery. This procedure provides significant relief from jaundice and cholestasis, with good long-term outcomes for many patients.
Area of Science:
- Gastroenterology
- Interventional Radiology
- Hepatology
Background:
- Benign bile duct stenoses often result from biliary surgery, pancreatic diseases, or sclerosing cholangitis.
- These strictures pose challenges for gastroenterologists and surgeons, particularly when endoscopic treatment is not feasible.
- The efficacy of percutaneous transhepatic stenting for these conditions requires further definition.
Purpose of the Study:
- To evaluate the safety and effectiveness of percutaneous transhepatic stenting for symptomatic benign bile duct strictures.
- To assess the long-term resolution of strictures and the tolerability of drainage removal after stenting.
- To define the role of percutaneous transhepatic stenting as a therapeutic option for benign biliary strictures.
Main Methods:
- A prospective study involving 36 patients with symptomatic benign bile duct stenoses or strictures post-surgery.
- Patients underwent percutaneous transhepatic stenting.
- Outcomes assessed included primary success rate, stricture resolution, clinical improvement, and long-term failure rates.
Main Results:
- The primary success rate of percutaneous transhepatic biliary drainage (PTBD) was 92% (33/36 patients), with all patients showing improvement in jaundice and cholestasis.
- Complete stricture relief and clinical improvement were achieved in 72% (26/36) of patients after a median stenting duration of 14.5 months.
- Long-term failures occurred in 27% (10/36) of patients after a median follow-up of 48 months.
Conclusions:
- Percutaneous transhepatic stenting is a safe and effective method for achieving adequate internal bile drainage in patients with symptomatic benign biliary strictures.
- The procedure offers both short-term interventional benefits and a viable long-term alternative to surgical intervention.
- Tolerable complication rates support the use of percutaneous transhepatic stenting for benign biliary strictures.
Purpose:
The occurrence of benign bile duct stenoses is mostly associated with prior biliary surgery, pancreatic diseases or sclerosing cholangitis. It remains a challenging problem for gastroenterologists and surgeons, especially in case the endoscopic approach is not possible. The exact role of percutaneous transhepatic stenting for these patients has not been clearly defined yet.
Material And Methods:
36 patients with symptomatic benign bile duct stenoses or strictures after surgery underwent percutaneous transhepatic stenting and were studied prospectively. We were particularly interested in how many patients would achieve resolution of the stricture and tolerate removal of the drainage in the long-run.
Results:
The primary success rate of percutaneous transhepatic biliary drainage (PTBD) was 92% (33/36 patients). All patients presented improvement of jaundice and cholestasis. Relief of the stricture and clinical improvement was achieved in 72% (26/36) of patients after a median stenting time of 14.5 (6-34) months. 5.5% (2/36) required further stenting due to a persistent stricture. A clinical recovery without radiological stricture regression after stenting demonstrated 22% (8/36) of patients. Long-term failures were noted in 27% (10/36) of patients after a median follow-up of 48 months.
Conclusions:
Percutaneous transhepatic stenting of symptomatic benign biliary strictures is safe and highly effective in achieving adequate internal bile drainage. There seems to be a therapeutic benefit not only for short-term interventional treatment but also as a sufficient long-term therapeutic alternative to surgery with tolerable complication rates.
