title: Percutaneous intervention strategies for the management of dysfunctioning biliary plastic endoprostheses in patients with malignant biliary obstruction.
abstract: OBJECTIVE
  To present our clinical experience and to suggest different strategies in the management of dysfunctioning plastic biliary stents in patients with malignant biliary obstruction.
  
  
  METHODS
  Twenty females and 23 males with a mean age of 64.8 years (range, 30-89 years) with malignant obstructive jaundice were referred to the interventional radiology department due to previously inserted dysfunctioning plastic endoprostheses. Pancreatic carcinoma (n=12), duodenal carcinoma (n=5), cholangiocarcinoma (n=16), gallbladder cancer (n=4), and metastatic disease (n=6) had been previously stented endoscopically. Nine of the patients had two plastic endoprostheses in the biliary tree. Forty-nine endoprostheses were straight polyethylene stents, and three were double-J type plastic stents (52 endoprostheses in total).
  
  
  RESULTS
  Forty-nine of the dysfunctioning plastic stents were cleared from the biliary tree. Of these, 31 were dislodged into the bowel with the help of a balloon catheter. Threading with an over-the-wire diagnostic and percutaneous biliary drainage catheter was performed in 12 of the plastic stents. Six dysfunctioning endoprostheses were removed by transhepatic access. Three plastic endoprostheses could not be removed or dislodged. No complication occurred due to intervention. The mean follow-up time was nine months (range, 1-19 months). All of the patients were evaluated in the first month, and then at three-month intervals. Percutaneous metallic stenting was performed on 29 patients.
  
  
  CONCLUSIONS
  Percutaneous intervention should be considered as an alternative treatment when a need for eliminating the dysfunctioning plastic stent arises. Both removal of the dysfunctioning stent and dislodgement into the bowel are safe and efficient strategies in the management of malignant biliary obstructions.
authors.affiliation: Department of Interventional Radiology, Başkent University İstanbul Hospital, İstanbul, Turkey. burcakgumus73@yahoo.com
authors.forename: Burçak
authors.initials: B
authors.lastname: Gümüş
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D018281:Cholangiocarcinoma / Q000150:complications / Q000473:pathology / Q000601:surgery; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D015331:Cohort Studies; D020878:Device Removal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010969:Plastics; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D010969:Plastics