Rapid Communication
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Apr 21, 2006; 12(15): 2423-2426
Published online Apr 21, 2006. doi: 10.3748/wjg.v12.i15.2423
One-step palliative treatment method for obstructive jaundice caused by unresectable malignancies by percutaneous transhepatic insertion of an expandable metallic stent
Hiroshi Yoshida, Yasuhiro Mamada, Nobuhiko Taniai, Yoshiaki Mizuguchi, Tetsuya Shimizu, Shigeki Yokomuro, Takayuki Aimoto, Yoshiharu Nakamura, Eiji Uchida, Yasuo Arima, Manabu Watanabe, Eiichi Uchida, Takashi Tajiri
Hiroshi Yoshida, Yasuhiro Mamada, Nobuhiko Taniai, Yoshiaki Mizuguchi, Tetsuya Shimizu, Shigeki Yokomuro, Takayuki Aimoto, Yoshiharu Nakamura, Eiji Uchida, Yasuo Arima, Takashi Tajiri, Department of Surgery 1, Nippon Medical School, Japan
Manabu Watanabe, Eiichi Uchida, Uchida Hospital, Japan
Correspondence to: Hiroshi Yoshida, MD, Department of Surgery 1, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan. hiroshiy@nms.ac.jp
Telephone: +81-3-58146239 Fax: +81-3-56850989
Received: December 21, 2005
Revised: December 22, 2005
Accepted: January 14, 2006
Published online: April 21, 2006
Abstract

AIM: To describe a simple one-step method involving percutaneous transhepatic insertion of an expandable metal stent (EMS) used in the treatment of obstructive jaundice caused by unresectable malignancies.

METHODS: Fourteen patients diagnosed with obstructive jaundice due to unresectable malignancies were included in the study. The malignancies in these patients were a result of very advanced carcinoma or old age. Percutaneous transhepatic cholangiography was performed under ultrasonographic guidance. After a catheter with an inner metallic guide was advanced into the duodenum, an EMS was placed in the common bile duct, between a point 1 cm beyond the papilla of Vater and the entrance to the hepatic hilum. In cases where it was difficult to span the distance using just a single EMS, an additional stent was positioned. A drainage catheter was left in place to act as a hemostat. The catheter was removed after resolution of cholestasis and stent patency was confirmed 2 or 3 d post-procedure.

RESULTS: One-step insertion of the EMS was achieved in all patients with a procedure mean time of 24.4 min. Out of the patients who required 2 EMS, 4 needed a procedure time exceeding 30 min. The mean time for removal of the catheter post-procedure was 2.3 d. All patients died of malignancy with a mean follow-up time of 7.8 mo. No stent-related complication or stent obstruction was encountered.

CONCLUSIONS: One-step percutaneous transhepatic insertion of EMS is a simple procedure for resolving biliary obstruction and can effectively improve the patient’s quality of life.

Keywords: Expandable metallic stent; Bile duct carcinoma; Gall bladder carcinoma; Pancreatic carcinoma; Gastric carcinoma; Obstructive jaundice