Endoscopic biliary therapy using the combined percutaneous and endoscopic technique.

Area of Science:

• Gastroenterology
• Interventional Radiology
• Hepatobiliary Surgery

Background:

• Endoscopic retrograde cholangiopancreatography (ERCP) is a primary treatment for biliary obstruction.
• Some patients fail ERCP-alone or have contraindications for surgery.
• Alternative approaches are needed for complex biliary disease.

Purpose of the Study:

• To evaluate the efficacy and safety of a combined percutaneous transhepatic and endoscopic transpapillary approach for biliary therapy.
• To assess outcomes in patients with malignant and benign biliary disease who failed prior endoscopic treatment.
• To determine the role of this combined procedure in managing complex biliary obstructions.

Main Methods:

• A retrospective review of 74 patients undergoing a combined procedure between September 1985 and December 1987.
• Initial percutaneous transhepatic access to the biliary tree followed by external drainage.
• Subsequent combined endoscopic transpapillary intervention for palliation or treatment.

Main Results:

• The combined procedure was successful in 60 out of 72 cases (83%).
• Success rates were 80% for malignant strictures, 83% for common duct stones, and 100% for benign strictures.
• Procedure-related morbidity was 12.5% for benign and 36% for malignant disease, with mortality rates of 0% and 3%, respectively.

Conclusions:

• The combined percutaneous transhepatic and endoscopic transpapillary approach enhances nonsurgical treatment options for high-risk patients with biliary disease.
• This technique improves outcomes for malignant biliary obstruction and benign biliary stenosis.
• Despite its benefits, the combined procedure is associated with considerable morbidity and mortality, particularly in malignant cases.