[Antegrade endobiliary interventions in undilated bile ducts]

Area of Science:

• Hepatobiliary Surgery
• Interventional Radiology

Background:

• Endoscopic retrograde cholangiopancreatography (ERCP) is the primary modality for biliary interventions.
• ERCP may be impossible or ineffective in certain complex biliary diseases, necessitating alternative approaches.

Purpose of the Study:

• To evaluate the advisability and efficacy of the antegrade transhepatic approach for benign and malignant biliary diseases.
• To demonstrate the utility of this approach when endoscopic techniques are contraindicated or have failed.

Main Methods:

• A retrospective analysis of 38 patients who underwent percutaneous transhepatic cholangiostomy followed by endobiliary interventions between 2009 and 2016.
• Procedures included antegrade balloon dilatation of strictures, papillodilatation, and calculus removal.

Main Results:

• The antegrade transhepatic approach was effective in all patients, enabling successful biliary drainage and interventions.
• Specific manipulations included stricture dilatation, papillodilatation, and common bile duct stone extraction.
• Two complications occurred, including one fatality due to severe pancreatic necrosis.

Conclusions:

• Percutaneous transhepatic cholangiostomy is effective for temporary biliary drainage, fistula closure, and bile collection management.
• This method is indicated for elective endobiliary interventions in cases of choledocholithiasis and anastomotic strictures when conventional methods fail.