title: An innovative percutaneous technique for the removal and replacement of dysfunctioning plastic biliary endoprostheses (PBE) in the management of malignant billiary occlusions.
abstract: OBJECTIVE
  The purpose of this study was to assess the feasibility and clinical impact of the percutaneous removal and replacement of dysfunctioning plastic biliary endoprostheses (PBE).
  
  
  METHODS
  Over a period of 24 months, we observed eight patients (age 54-82 years; mean 65) with dysfunctioning PBE. After transhepatic cholangiography and bile duct catheterisation, the endoprostheses were grasped with a gooseneck snare and pushed into the duodenum using a long introducer sheath. Subsequently, we implanted six metallic stents in middle and distal occlusions and four plastic endoprostheses in two patients with proximal occlusion. Clinical and ultrasound followup was performed 1, 3 and 6 months after the procedure and then yearly.
  
  
  RESULTS
  The procedure was technically successful in all patients. No major complication occurred. All patients were discharged without biliary drainage catheters. During the follow-up period (mean: 7.1 months), four patients died and two occlusions of metallic stents were treated by implanting a further metallic stent.
  
  
  CONCLUSIONS
  Percutaneous removal of a dysfunctioning PBE is feasible and allows better quality of life owing to the absence of biliary drainage. Patency of metallic stents is higher than that of PBE. Larger studies are clearly required to validate this approach.
authors.affiliation: Vascular and Interventional Radiology, Department of Radiology, University of Insubria, Viale Borri 57, I-21100, Varese, Italy. donlaga@gmail.com
authors.forename: D
authors.initials: D
authors.lastname: Laganà
authors.forename: G
authors.initials: G
authors.lastname: Carrafiello
authors.forename: M
authors.initials: M
authors.lastname: Mangini
authors.forename: A
authors.initials: A
authors.lastname: Giorgianni
authors.forename: G
authors.initials: G
authors.lastname: Sturniolo
authors.forename: G
authors.initials: G
authors.lastname: Dionigi
authors.forename: S
authors.initials: S
authors.lastname: Cuffari
authors.forename: C
authors.initials: C
authors.lastname: Fugazzola
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D001661:Biliary Tract Neoplasms / Q000150:complications*; D002758:Cholangiography; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D020878:Device Removal; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D019736:Prostheses and Implants / Q000009:adverse effects*; D011475:Prosthesis Failure; D015642:Radiology, Interventional; D015607:Stents; D016896:Treatment Outcome