RESUMO
This review recalls the clinical, anatomic, physiopathological and etiological features necessary in the management of patients with neoplastic bile duct obstruction and exposes the current practice concerning endoscopic and radiologic palliative drainage. Clinical practice according to the clinical situations is explained. This review exposes complications management for patients having undergone an endoscopic or percutaneous drainage of the biliary ducts, the particular case of periportal stenosis, the respective indications of endoscopic and transhepatic percutaneous drainage, usual immediate evolution according to the type of the stenosis and the technique used as well as the management in case of stent obstruction.
Assuntos
Colestase/terapia , Neoplasias do Sistema Digestório/complicações , Drenagem/métodos , Cuidados Paliativos/métodos , Adenocarcinoma/complicações , Adenocarcinoma/secundário , Carcinoma Hepatocelular/complicações , Cateterismo/instrumentação , Cateterismo/métodos , Colangiocarcinoma/complicações , Colestase/etiologia , Neoplasias Colorretais/patologia , Constrição Patológica/etiologia , Drenagem/instrumentação , Endoscopia do Sistema Digestório/efeitos adversos , Humanos , Icterícia Obstrutiva/etiologia , Neoplasias Hepáticas/complicações , Falha de Prótese/etiologiaRESUMO
BACKGROUND: Percutaneous transhepatic balloon dilatation is an alternative to surgery when benign bilioenteric strictures (BBES) are inaccessible to endoscopic treatment. Our primary objective was to report long-term patency of balloon-dilated BBES. METHODS: A total of 110 consecutive patients with 155 BBES had percutaneous transhepatic complete drainage of all biliary territories, balloon dilatation, and catheter stenting. Intracorporeal electrohydraulic lithotripsy treated associated biliary stones. Biliary drains were removed when no residual balloon waists were observed on at least 2 consecutive sessions, 6 weeks apart. RESULTS: A total of 109 of 110 patients had complete drainage. Forty-five patients had successfully treated associated stones. Eleven patients had short-term complications. No patients died. The median follow-up period was 59 months (range, .5-278 mo). Twenty-three patients were lost to follow-up evaluation. Thirteen patients had recurrent biliary obstruction (15%). Life-table analysis showed 90.9% bilioenteric patency after 2,697 days. CONCLUSIONS: Percutaneous balloon dilatation and calibration of BBES provides acceptable morbidity and low long-term stricture recurrence.