Endoscopic duodenobiliary drainage in the treatment of pancreatobiliary neoplastic stenosis

• Khrustaleva M.V.
• D.G. Shatveryan
• Godzhello E.A.

Abstract

The article is devoted to the problem of restoring biliar flow-out in patients with malignancy occlusion of the biliary tract. The analysis of the efficacy and safety of endoscopic transpapillary duodenobiliary drainage based on the experience of the treatment of 367 patients. Transpapillary stenting was used as a method of preoperative decompression, and as a palliative interventions. Stenting was able to perform at 297 (80,9%) patients. The most effective intervention was in patients with stenosis in the middle part of the bile duct. The causes of failure were proximal localization of the stenosis, the long defeat duct and transition. The most frequent early complications of stenting were cholangitis and bleeding from the EPT zone. Analysis of the results of the initial duodenobiliary stenting showed that the efficiency of drainage does not depend on the diameter and number of implanted stents and therefore, in the primary intervention it is nessesary to insert a single stent average diameter (8–9 Fr) without EPT.

Out of the 279 patients surgical treatment was undertaken at 139 (46,8%) patients. In 158 (53,2%) patients, surgical treatment was not carried out, and endoscopic transpapillary stenting in these cases was the final version of palliative treatment. In 35 (22,2%) patients after primary stenting of polymer drains were installed metal self-expandable stents. With long-term stenting in unoperated patients required to fourth periodic replacement of polymeric drainage in connection with their occlusion. The time function of the stent depends on the diameter of the drainage with the introduction of a single implant, and the number entered drains with multiple stenting. With the aim of extending the functions of stents in palliative treatment should set the maximum number of drainage of large diameter or apply nitinol stents. In the study the authors concluded that transpapillary duodenobiliary drainage is an effective and safe method for the recovery of biliar flow-out when malignancy occlusion of the biliary tract and may be a method of preoperative preparation and the final version of palliative treatment.

Keywords:malignant jaundice, duodenobiliary drainage, plastic stents, nitinol stents

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)