Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2015; 21(44): 12628-12634
Published online Nov 28, 2015. doi: 10.3748/wjg.v21.i44.12628
Peripheral portal vein-oriented non-dilated bile duct puncture for percutaneous transhepatic biliary drainage
Hiroaki Shimizu, Atsushi Kato, Tsukasa Takayashiki, Satoshi Kuboki, Masayuki Ohtsuka, Hideyuki Yoshitomi, Katsunori Furukawa, Masaru Miyazaki
Hiroaki Shimizu, Atsushi Kato, Tsukasa Takayashiki, Satoshi Kuboki, Masayuki Ohtsuka, Hideyuki Yoshitomi, Katsunori Furukawa, Masaru Miyazaki, Department of General Surgery, Chiba University Graduate School of Medicine, Chiba City, Chiba Prefecture 260-8670, Japan
Author contributions: Shimizu H designed and performed the research and wrote the paper; Kato A, Takayashiki T and Kuboki S performed the research and contributed to the analysis; Ohtsuka M, Yoshitomi H, Furukawa K and Miyazaki M provided clinical advice and supervised the report.
Institutional review board statement: All procedures performed in studies involving human participants were in accordance with the ethical standards of the Chiba University Hospital. Because of the retrospective design, approval of the ethic commission was not always required.
Informed consent statement: Informed consent was obtained from all individual participants as to the percutaneous biliary drainage as part of the treatment for biliary disorders.
Conflict-of-interest statement: We have no potential conflicts of interest to declare.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at h-shimizu@faculty.chiba-u.jp. Consent was not obtained from the study participants because the present data are retrospective, de-identified, and anonymized; therefore, the risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hiroaki Shimizu, MD, Associate Professor, Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba Prefecture 260-8677, Japan. h-shimizu@faculty.chiba-u.jp
Telephone: +81-43-2227171 Fax: +81-43-2262552
Received: April 10, 2015
Peer-review started: April 11, 2015
First decision: June 19, 2015
Revised: July 31, 2015
Accepted: September 28, 2015
Article in press: September 30, 2015
Published online: November 28, 2015
Processing time: 230 Days and 19.8 Hours
Abstract

AIM: To evaluate the efficacy of peripheral portal vein (PV)-oriented non-dilated bile duct (BD) puncture for percutaneous transhepatic biliary drainage (PTBD).

METHODS: Thirty-five patients with non-dilated BDs underwent PTBD for the management of various biliary disorders, including benign bilioenteric anastomotic stricture (n = 24), BD stricture (n = 5) associated with iatrogenic BD injury, and postoperative biliary leakage (n = 6). Under ultrasonographic guidance, percutaneous transhepatic puncture using a 21-G needle was performed along the running course of the peripheral targeted non-dilated BD (preferably B6 for right-sided approach, and B3 for left-sided approach) or along the accompanying PV when the BD was not well visualized. This technique could provide an appropriate insertion angle of less than 30° between the puncture needle and BD running course. The puncture needle was then advanced slightly beyond the accompanying PV. The needle tip was moved slightly backward while injecting a small amount of contrast agent to obtain the BD image, followed by insertion of a 0.018-inch guide wire (GW). A drainage catheter was then placed using a two-step GW method.

RESULTS: PTBD was successful in 33 (94.3%) of the 35 patients with non-dilated intrahepatic BDs. A right-sided approach was performed in 25 cases, while a left-sided approach was performed in 10 cases. In 31 patients, the first PTBD attempt proved successful. Four cases required a second attempt a few days later to place a drainage catheter. PTBD was successful in two cases, but the second attempt also failed in the other two cases, probably due to poor breath-holding ability. Although most patients (n = 26) had been experiencing cholangitis with fever (including septic condition in 8 cases) before PTBD, only 5 (14.3%) patients encountered PTBD procedure-related complications, such as transient hemobilia and cholangitis. No major complications such as bilioarterial fistula or portal thrombosis were observed. There was no mortality in our series.

CONCLUSION: Peripheral PV-oriented BD puncture for PTBD in patients with non-dilated BDs is a safe and effective procedure for BD stricture and postoperative bile leakage.

Keywords: Percutaneous transhepatic biliary drainage; Cholangitis; Obstructive jaundice; Non-dilated bile duct

Core tip: Percutaneous transhepatic biliary drainage (PTBD) offers a valuable alternative for access to the biliary system when endoscopic biliary drainage is impossible or infeasible. PTBD is generally performed in jaundiced patients with dilated bile ducts (BDs). However, some patients inevitably require PTBD even in the absence of dilated BD. Achieving needle access to the non-dilated BD is a challenging procedure. The present study reported on detailed technical aspects of peripheral portal vein-oriented BD puncture for PTBD in patients with non-dilated BDs, and also examined the safety and success rates of this procedure.