Pitfalls of percutaneous-endoscopic biliary stent placement

Percutaneously inserted transhepatic guide wire improves the success rate of endoscopic biliary stenting. However, we have encountered several pitfalls with this approach. In one patient, as a result of the stability provided by the transhepatic guide wire, the stent was pushed excessively into the liver parenchyma. In another patient, the proximal end of the stent was embedded in liver parenchyma in the lateral view during fluoroscopy, despite apparently good positioning in the anteroposterior view. Avoidance of central puncture during establishment of percutaneous transhepatic biliary drainage and checking two planes with fluoroscopy may help to reduce this risk. Close attention to these potential technical pitfalls would further improve the success rate of endoscopic biliary stenting.