TRANSJUGULAR INSERTION OF BILIARY STENTS (TIBS) IN 2 PATIENTS WITH MALIGNANT OBSTRUCTION, ASCITES, AND COAGULOPATHY

Two patients with pancreatic malignancies presented with biliary obstr uction which could not be treated from an endoscopic approach, Standar d transhepatic biliary drainage was relatively contraindicated because of moderate ascites and coagulopathy related to underlying liver dise ase. In one patient, a transjugular, transvenous approach was used to deliver a Wallstent endoprosthesis across the distal common bile duct obstruction in a single step procedure. In the second case, a previous ly placed biliary Wallstent was revised with an additional stent from a similar approach. Transjugular biliary catheterization offers a valu able alternative approach for primary stent placement or revision in p atients with contraindication to standard transhepatic drainage.