title: Combined percutaneous transhepatic and endoscopic placement of biliary stents.
abstract: Combined percutaneous transhepatic cholangiography and endoscopic retrograde cholangiography can be used to stent biliary obstruction when attempts at endoscopic stenting have failed. Between January 1987 and August 1991 we performed 35 combined procedures in 31 patients with malignant obstruction. Post stenting serum bilirubin and serum alkaline phosphatase concentration fell after 33 and 29 procedures, respectively. In six studies there was evidence of infection prior to stenting. In spite of the use of prophylactic antibiotics, septic complications developed after eight procedures (23%). Pseudomonas was the most commonly isolated pathogen (46%). Twenty-three patients were discharged, 30-day mortality was 8 (23%) and median survival was 14 weeks (range 0-75 weeks). Seven patients required eight stent changes because of blockage (median patency time 18 weeks; range 7-75 weeks). Use of this technique allows relief of biliary obstruction. Potential infective and bleeding complications must be anticipated.
authors.affiliation: Department of Medicine, St Mary's Hospital Medical School, Imperial College, London, UK.
authors.forename: J B
authors.initials: JB
authors.lastname: Hunt
authors.forename: J M
authors.initials: JM
authors.lastname: Sayer
authors.forename: M
authors.initials: M
authors.lastname: Jacyna
authors.forename: M
authors.initials: M
authors.lastname: Crofton
authors.forename: J A
authors.initials: JA
authors.lastname: Summerfield
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood; D000681:Amylases / Q000097:blood; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001663:Bilirubin / Q000097:blood; D002758:Cholangiography / Q000379:methods*; D002779:Cholestasis / Q000097:blood / Q000401:mortality / Q000628:therapy*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011292:Premedication; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D015996:Survival Rate
chemical_list: D000900:Anti-Bacterial Agents; D006454:Hemoglobins; D000469:Alkaline Phosphatase; D000681:Amylases; D001663:Bilirubin