title: Percutaneous transhepatic biliary drainage using a ligated catheter for recurrent catheter obstruction: antireflux technique.
abstract: Percutaneous transhepatic biliary drainage (PTBD) is an established procedure for biliary obstruction. However, duodenobiliary or jejunobiliary reflux of the intestinal contents through a PTBD catheter sometimes causes recurrent catheter obstruction or cholangitis. A 64-year-old female patient with a history of choledochojejunostomy was referred to our department with acute cholangitis due to choledochojejunal anastomotic obstruction. Emergent PTBD was performed, but frequent obstructions of the catheter due to the reflux of intestinal contents complicated the post-PTBD course. We therefore introduced a catheter with an antireflux mechanism to prevent jejunobiliary reflux. A commercially available catheter was modified; side holes were made at 1 cm and 5 to 10 cm (1 cm apart) from the tip of the catheter, and the catheter was ligated with a nylon thread just proximal to the first side hole. Using this novel "antireflux PTBD technique," jejunobiliary reflux was prevented successfully, resulting in a longer patency of the catheter.
authors.affiliation: Department of Gastroenterology, Japanese Red Cross Medical Center, Tokyo, Japan. ; Department of Gastroenterology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Hamada
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsujino
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.forename: Ryunosuke
authors.initials: R
authors.lastname: Hakuta
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Ito
authors.forename: Ryo
authors.initials: R
authors.lastname: Nakata
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
keywords: Catheters; Cholangitis; Choledochostomy; Drainage
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