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Semin intervent Radiol 2016; 33(04): 283-290
DOI: 10.1055/s-0036-1592327
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Biliary Interventions: Tools and Techniques of the Trade, Access, Cholangiography, Biopsy, Cholangioscopy, Cholangioplasty, Stenting, Stone Extraction, and Brachytherapy

Osman Ahmed
1   Division of Interventional Radiology, Department of Radiology, Rush University Medical Center, Chicago, Illinois
,
Sipan Mathevosian
2   Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois
,
Bulent Arslan
1   Division of Interventional Radiology, Department of Radiology, Rush University Medical Center, Chicago, Illinois
› Author Affiliations
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Publication History

Publication Date:
31 October 2016 (online)

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Abstract

Therapeutic access to the biliary system is generally limited to endoscopic or percutaneous approaches. A variety of percutaneous transhepatic biliary interventions are applicable for the diagnosis and treatment of biliary system pathologies, the majority of which may be performed in conjunction with one another. The backbone of nearly all of these interventions is percutaneous transhepatic cholangiography for opacification of the biliary tree, after which any number of therapeutic or diagnostic modalities may be pursued. We describe an overview of the instrumentation and technical approaches for several fundamental interventional procedures, including percutaneous transhepatic cholangiography and internal/external biliary drainage, endobiliary biopsy techniques, cholangioscopy, cholangioplasty and biliary stenting, biliary stone extraction, and intraluminal brachytherapy.

Keywords

biliary interventions - cholangiography - cholangioplasty - biliary stenting - interventional radiology
 

  • References

  • 1 Watkinson AF, Adam A. Interventional Radiology: A Practical Guide. United Kingdom: Radcliffe Publishing; 1996
    Google Scholar
  • 2 Funaki B. Percutaneous biliary drainage. Semin Intervent Radiol 2007; 24 (2) 268-271
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Venkatesan AM, Kundu S, Sacks D , et al; Society of Interventional Radiology Standards of Practice Committee. Practice guidelines for adult antibiotic prophylaxis during vascular and interventional radiology procedures. Written by the Standards of Practice Committee for the Society of Interventional Radiology and Endorsed by the Cardiovascular Interventional Radiological Society of Europe and Canadian Interventional Radiology Association [corrected]. J Vasc Interv Radiol 2010; 21 (11) 1611-1630 , quiz 16310
    CrossrefPubMedGoogle Scholar
  • 4 Baijal SS, Dhiman RK, Gupta S , et al. Percutaneous transhepatic biliary drainage in the management of obstructive jaundice. Trop Gastroenterol 1997; 18 (4) 167-171
    PubMedGoogle Scholar
  • 5 Jung GS, Huh JD, Lee SU, Han BH, Chang HK, Cho YD. Bile duct: analysis of percutaneous transluminal forceps biopsy in 130 patients suspected of having malignant biliary obstruction. Radiology 2002; 224 (3) 725-730
    CrossrefPubMedGoogle Scholar
  • 6 Hall-Craggs MA, Lees WR. Fine-needle aspiration biopsy: pancreatic and biliary tumors. AJR Am J Roentgenol 1986; 147 (2) 399-403
    CrossrefPubMedGoogle Scholar
  • 7 Ahrar K, Gupta S. Percutaneous Image Guided Biopsy. New York: Springer Publishing; 2014
    CrossrefGoogle Scholar
  • 8 Ponchon T, Gagnon P, Berger F , et al. Value of endobiliary brush cytology and biopsies for the diagnosis of malignant bile duct stenosis: results of a prospective study. Gastrointest Endosc 1995; 42 (6) 565-572
    CrossrefPubMedGoogle Scholar
  • 9 Brugge WR, De Witt J, Klapman JB , et al. Techniques for cytologic sampling of pancreatic and bile duct lesions: The Papanicolaou Society of Cytopathology Guidelines. Cytojournal 2014; 11 (Suppl. 01) 2
    CrossrefPubMedGoogle Scholar
  • 10 Sugimoto S, Matsubayashi H, Kimura H , et al. Diagnosis of bile duct cancer by bile cytology: usefulness of post-brushing biliary lavage fluid. Endosc Int Open 2015; 3 (4) E323-E328
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Barkun A, Liu J, Carpenter S , et al; Technology Assessment Committee. Update on endoscopic tissue sampling devices. Gastrointest Endosc 2006; 63 (6) 741-745
    CrossrefPubMedGoogle Scholar
  • 12 Sato M, Inoue H, Ogawa S , et al. Limitations of percutaneous transhepatic cholangioscopy for the diagnosis of the intramural extension of bile duct carcinoma. Endoscopy 1998; 30 (3) 281-288
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Jung JY, Lee SK, Oh HC , et al. The role of percutaneous transhepatic cholangioscopy in patients with hilar strictures. Gut Liver 2007; 1 (1) 56-62
    CrossrefPubMedGoogle Scholar
  • 14 Chin MW, Byrne MF. Update of cholangioscopy and biliary strictures. World J Gastroenterol 2011; 17 (34) 3864-3869
    CrossrefPubMedGoogle Scholar
  • 15 Shah RJ, Adler DG, Conway JD , et al; ASGE Technology Committee. Cholangiopancreatoscopy. Gastrointest Endosc 2008; 68 (3) 411-421
    CrossrefPubMedGoogle Scholar
  • 16 Kow AW, Wang B, Wong D , et al. Using percutaneous transhepatic cholangioscopic lithotripsy for intrahepatic calculus in hostile abdomen. Surgeon 2011; 9 (2) 88-94
    CrossrefPubMedGoogle Scholar
  • 17 Lee JH, Kim HW, Kang DH , et al. Usefulness of percutaneous transhepatic cholangioscopic lithotomy for removal of difficult common bile duct stones. Clin Endosc 2013; 46 (1) 65-70
    CrossrefPubMedGoogle Scholar
  • 18 Wang P, Chen X, Sun B, Liu Y. Application of combined rigid choledochoscope and accurate positioning method in the adjuvant treatment of bile duct stones. Int J Clin Exp Med 2015; 8 (9) 16550-16556
    PubMedGoogle Scholar
  • 19 Bonnel DH, Liguory CE, Cornud FE, Lefebvre JF. Common bile duct and intrahepatic stones: results of transhepatic electrohydraulic lithotripsy in 50 patients. Radiology 1991; 180 (2) 345-348
    CrossrefPubMedGoogle Scholar
  • 20 Oh HC, Lee SK, Lee TY , et al. Analysis of percutaneous transhepatic cholangioscopy-related complications and the risk factors for those complications. Endoscopy 2007; 39 (8) 731-736
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Ponchon T, Genin G, Mitchell R , et al. Methods, indications, and results of percutaneous choledochoscopy. A series of 161 procedures. Ann Surg 1996; 223 (1) 26-36
    CrossrefPubMedGoogle Scholar
  • 22 Yoshimoto H, Ikeda S, Tanaka M, Matsumoto S. Relationship of biliary pressure to cholangiovenous reflux during endoscopic retrograde balloon catheter cholangiography. Dig Dis Sci 1989; 34 (1) 16-20
    CrossrefPubMedGoogle Scholar
  • 23 Madhusudhan KS, Gamanagatti S, Gupta AK. Imaging and interventions in hilar cholangiocarcinoma: a review. World J Radiol 2015; 7 (2) 28-44
    CrossrefPubMedGoogle Scholar
  • 24 Weber A, Schmid RM, Prinz C. Diagnostic approaches for cholangiocarcinoma. World J Gastroenterol 2008; 14 (26) 4131-4136
    CrossrefPubMedGoogle Scholar
  • 25 Mönkemüller K, Wilcox CM, Muñoz-Navas M. Interventional and Therapeutic Gastrointestinal Endoscopy. Switzerland: Karger Medical and Scientific Publishers; 2010
    Google Scholar
  • 26 Harrod-Kim P. Tumor ablation with photodynamic therapy: introduction to mechanism and clinical applications. J Vasc Interv Radiol 2006; 17 (9) 1441-1448
    CrossrefPubMedGoogle Scholar
  • 27 Pfau PR, Pleskow DK, Banerjee S , et al; ASGE Technology Assessment Committee. Pancreatic and biliary stents. Gastrointest Endosc 2013; 77 (3) 319-327
    CrossrefPubMedGoogle Scholar
  • 28 Irving JD, Adam A, Dick R, Dondelinger RF, Lunderquist A, Roche A. Gianturco expandable metallic biliary stents: results of a European clinical trial. Radiology 1989; 172 (2) 321-326
    CrossrefPubMedGoogle Scholar
  • 29 Lee SJ, Kim MD, Lee MS , et al. Comparison of the efficacy of covered versus uncovered metallic stents in treating inoperable malignant common bile duct obstruction: a randomized trial. J Vasc Interv Radiol 2014; 25 (12) 1912-1920
    CrossrefPubMedGoogle Scholar
  • 30 George C, Byass OR, Cast JE. Interventional radiology in the management of malignant biliary obstruction. World J Gastrointest Oncol 2010; 2 (3) 146-150
    CrossrefPubMedGoogle Scholar
  • 31 Huang X, Shen L, Jin Y , et al. Comparison of uncovered stent placement across versus above the main duodenal papilla for malignant biliary obstruction. J Vasc Interv Radiol 2015; 26 (3) 432-437
    CrossrefPubMedGoogle Scholar
  • 32 Corvino F, Centore L, Soreca E, Corvino A, Farbo V, Bencivenga A. Percutaneous “Y” biliary stent placement in palliative treatment of type 4 malignant hilar stricture. J Gastrointest Oncol 2016; 7 (2) 255-261
    PubMedGoogle Scholar
  • 33 Park YS, Kim JH, Choi YW , et al. Percutaneous treatment of extrahepatic bile duct stones assisted by balloon sphincteroplasty and occlusion balloon. Korean J Radiol 2005; 6 (4) 235-240
    CrossrefPubMedGoogle Scholar
  • 34 Ryu JK. Percutaneous approach for removal of difficult common bile duct stones. Clin Endosc 2013; 46 (1) 3-4
    CrossrefPubMedGoogle Scholar
  • 35 Yee AC, Ho CS. Complications of percutaneous biliary drainage: benign vs malignant diseases. AJR Am J Roentgenol 1987; 148 (6) 1207-1209
    CrossrefPubMedGoogle Scholar
  • 36 Chen Y, Wang XL, Yan ZP , et al. HDR-192Ir intraluminal brachytherapy in treatment of malignant obstructive jaundice. World J Gastroenterol 2004; 10 (23) 3506-3510
    CrossrefPubMedGoogle Scholar
  • 37 Eschelman DJ, Shapiro MJ, Bonn J , et al. Malignant biliary duct obstruction: long-term experience with Gianturco stents and combined-modality radiation therapy. Radiology 1996; 200 (3) 717-724
    CrossrefPubMedGoogle Scholar
  • 38 Singh RR, Singh V. Endoscopic management of hilar biliary strictures. World J Gastrointest Endosc 2015; 7 (8) 806-813
    PubMedGoogle Scholar
  • 39 Skowronek J, Sowier A, Skrzywanek P. Intraluminal pulsed dose rate (PDR) brachytherapy and trans-hepatic technique in treatment of locally advanced bile duct cancer – preliminary assessment. Rep Pract Oncol Radiother 2007; 12 (2) 125-133
    CrossrefPubMedGoogle Scholar
  • 40 Ghafoori AP, Nelson JW, Willett CG , et al. Radiotherapy in the treatment of patients with unresectable extrahepatic cholangiocarcinoma. Int J Radiat Oncol Biol Phys 2011; 81 (3) 654-659
    CrossrefPubMedGoogle Scholar
  • 41 Yoshida K, Yamazaki H, Nakamara S , et al. Comparison of common terminology criteria for adverse events v3.0 and radiation therapy oncology group toxicity score system after high-dose-rate interstitial brachytherapy as monotherapy for prostate cancer. Anticancer Res 2014; 34 (4) 2015-2018
    PubMedGoogle Scholar