title: Percutaneous transhepatic biliary drainage and occlusion balloon in the management of duodenal stump fistula.
abstract: BACKGROUND
  Duodenal stump fistula (DSF) after gastrectomy is a complication with a high mortality rate. We report a series of patients with postoperative DSF treated with percutaneous transhepatic biliary drainage and occlusion balloon (PTBD-OB). The aim of this study is to explore the feasibility and efficacy of PTBD-OB in the treatment of DSF.
  
  
  METHODS
  Six patients developing DSF underwent PTBD-OB because of high DSF output and because medical and surgical management was unsuccessful. In these patients, an occlusion balloon was percutaneously inserted into the common bile duct and a biliary drain was positioned above the balloon to obtain external drainage of bile.
  
  
  RESULTS
  In all cases, percutaneous access to the biliary tree was achieved. Patients maintained the PTBD-OB for a median of 43 days. In all patients, DSF output decreased after PTBD-OB placement from a median of 500 to 100 ml/day (p = 0.02). The DSF resolved in three patients and three patients died of sepsis, but in two of them, death was related to other digestive fistulas that developed before PTBD-OB placement.
  
  
  CONCLUSIONS
  This paper presents the first published series on DSF management with PTBD-OB and shows that it is a feasible and safe procedure which reduces DSF output.
authors.affiliation: Division of Surgical Oncology, IRCCS Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, MI, Italy. felugia@libero.it
authors.forename: Luca
authors.initials: L
authors.lastname: Cozzaglio
authors.forename: Matteo
authors.initials: M
authors.lastname: Cimino
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mauri
authors.forename: Antonella
authors.initials: A
authors.lastname: Ardito
authors.forename: Vittorio
authors.initials: V
authors.lastname: Pedicini
authors.forename: Dario
authors.initials: D
authors.lastname: Poretti
authors.forename: Giorgio
authors.initials: G
authors.lastname: Brambilla
authors.forename: Matteo
authors.initials: M
authors.lastname: Sacchi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Melis
authors.forename: Roberto
authors.initials: R
authors.lastname: Doci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion; D001653:Bile Ducts, Intrahepatic; D004322:Drainage; D004378:Duodenal Diseases / Q000209:etiology / Q000628:therapy*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric