[Ultrasound-guided endoscopic drainage, without radiological examination, in patients with neoplastic biliary obstruction. Preliminary results].
OBJECTIVE
Endoscopic stent insertion has become the preferred method for palliation of malignant biliary obstruction. Currently, endoscopic stent placement involves the use of contrast media and radiological equipment to achieve direct opacification of the biliary duct systems, and to determine the location and the extension of biliary obstruction. This report proposes a new combination of ultrasonography and biliary endoscopy, with endoscopic stent placement entirely performed under US-guidance.


METHODS
US-guided stent placement was carried out in 8 patients. A guide-wire and a guiding-catheter were endoscopically introduced and identified, by US, the common bile duct across the stricture. Hydromer-coated polyurethane angled stents (10F) were finally inserted over the guide-wire/guiding-catheter by a pusher tube system.


RESULTS
Successful stent insertion was achieved in all patients. There were no complications. Successful drainage, with substantial reduction in bilirubin level, was achieved in all patients (14.2+/-9.5 vs 4.2+/-2.9 mg/dl at 1 week).


CONCLUSIONS
Endoscopic stent placement performed under US-guidance, is safe and effective. Further studies in a larger series, including more proximal strictures are suggested.
Dipartimento di Chirurgia Generale e Tecnologie Avanzate, Settore Funzionale di Diagnostica e Terapia Endoscopica, Università degli Studi Federico II, Facoltà di Medicina e Chirurgia, Napoli, Italy. gdepalma@arrotino.it
G D
GD
De Palma
A
A
Puzziello
G
G
Aprea
F
F
Persico
M
M
Rega
P
P
Ciamarra
F
F
Patrone
S
S
Masone
M
M
Di Marino
M
M
Persico
L
L
Mastantuono
L
L
Noceroni
G
G
Persico
D000368:Aged; D014670:Ampulla of Vater; D001651:Cholestasis, Extrahepatic / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D003138:Common Bile Duct Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging; D004322:Drainage; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications*; D011140:Polyurethanes; D012449:Safety; D015607:Stents; D016896:Treatment Outcome; D014463:Ultrasonography
D011140:Polyurethanes