Contrast-free endoscopic stent insertion in malignant biliary obstruction.
OBJECTIVE
To present a case series of MRCP-guided endoscopic biliary stent placement, performed entirely without contrast injection.


METHODS
Contrast-free endoscopic biliary drainage was attempted in 20 patients with malignant obstruction, unsuitable for resection on the basis of tumor extent or medical illness. MRCP images were used to confirm the diagnosis of tumor, to exclude other biliary diseases and to demonstrate the stenoses as well as dilation of proximal liver segments. The procedure was carried out under conscious sedation. Patients were placed in the left lateral decubitus position. The endoscope was inserted, the papilla identified and cannulated by a papillotome. A guide wire was inserted and guided deeply into the biliary tree, above the stenosis, by fluoroscopy. A papillotomy approximately 1 cm. long was performed and the papillotome was exchanged with a guiding-catheter. A 10 Fr, Amsterdam-type plastic stent, 7 to 15 cm long, was 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 major complications. Successful drainage, with substantial reduction in bilirubin levels, was achieved in all patients.


CONCLUSIONS
This new method of contrast-free endoscopic stenting in malignant biliary obstruction is a safe and effective method of palliation. However, a larger, randomized study comparing this new approach with the standard procedure is needed to confirm the findings of the present study.
Department of General Surgery, Oncologic Surgery and Advanced Technologies-Center for Technical Innovation in Surgery, University of Naples Federico II, School of Medicine, Via Pansini, 5. 80131 Naples, Italy. giovanni.depalma@unina.it
Giovanni D
GD
De Palma
Giovanni
G
Lombardi
Maria
M
Rega
Immacolata
I
Simeoli
Stefania
S
Masone
Saverio
S
Siciliano
Francesco
F
Maione
Francesca
F
Salvatori
Antonio
A
Balzano
Giovanni
G
Persico
D000368:Aged; D002779:Cholestasis / Q000175:diagnosis* / Q000628:therapy*; D003287:Contrast Media / Q000494:pharmacology; D004322:Drainage; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery; D010969:Plastics; D015607:Stents; D016896:Treatment Outcome; D014741:Video Recording
D003287:Contrast Media; D010969:Plastics