title: Percutaneous transcholecystic metallic stent placement for malignant obstruction of the common bile duct: preliminary clinical evaluation.
abstract: OBJECTIVE
  To evaluate the technical success and clinical effectiveness of percutaneous transcholecystic placement of self-expanding metallic stents for the treatment of malignant obstructions of the common bile duct.
  
  
  METHODS
  Fifteen patients with malignant obstruction at the lower level of the common bile duct not amenable to surgery were retrospectively reviewed in this study. In all patients, conventional biliary drainage via transhepatic peripheral duct access or endoscopic retrograde biliary drainage (ERBD) were technically difficult or deemed so at imaging evaluation. The causes of obstruction were cholangiocarcinoma (n = 7), pancreatic carcinoma (n = 6), and metastatic lymphadenopathy from gastric carcinoma in the hepatoduodenal ligament (n = 2). Following percutaneous cholecystostomy, a 5-F catheter was inserted into the common bile duct, duodenum, or the anastomosed jejunum through the cystic duct and the malignant obstruction and metallic stents were placed. The technical success was defined as the removal of the drainage tube after the stent placement for the obstruction. The mean follow-up period was 25.4 months.
  
  
  RESULTS
  Sixteen stents were placed in 15 patients. Technical success was achieved in all patients (100%) without major complications. Minor complications included controllable pain or self-limited hemobilia in six of the 15 patients (40%). Lower bilirubin levels compared with those before the procedure were achieved in 14 of the 15 patients (93%).
  
  
  CONCLUSIONS
  Percutaneous transcholecystic placement of metallic stents is a feasible and effective method to manage malignant obstruction at the lower level of the common bile duct not amenable to surgery when conventional biliary drainage via transhepatic peripheral duct access or ERBD were technically difficult or deemed so at imaging evaluation.
authors.affiliation: Department of Radiology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka City, Osaka 560-8565, Japan. yasumoto@solid.ocn.ne.jp
authors.forename: Taku
authors.initials: T
authors.lastname: Yasumoto
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Yokoyama
authors.forename: Koji
authors.initials: K
authors.lastname: Nagaike
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002767:Cholecystostomy; D001651:Cholestasis, Extrahepatic / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D003135:Common Bile Duct / Q000000981:diagnostic imaging; D004067:Digestive System Neoplasms / Q000150:complications* / Q000473:pathology / Q000556:secondary; D004322:Drainage / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D010865:Pilot Projects; D011474:Prosthesis Design; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
chemical_list: D008670:Metals