Percutaneous management of occluded biliary duct endoprostheses

Purpose: To present interventional methods for percutaneous treatment of pa tients with occluded bile duct endoprostheses. Material and Methods: Thirteen patients with endoscopically inserted occlud ed or damaged bile duct endoprostheses and recurrent jaundice were treated percutaneously. Endoscopic treatment was not available in 2 cases and unsuc cessful in Il other patients. Eleven interventions were performed under sys temic sedation and local anaesthesia and 2 under general anaesthesia. The e ndoprostheses were dislodged to the bowel using different interventional de vices. Adequate bile duct drainage was subsequently achieved by insertion o f self-expanding metallic stents. Results: All procedures were accomplished successfully and without immediat e serious complications. Two metallic stents and 18 plastic endoprostheses were dislodged to the bowel using percutaneous interventional techniques. O ne plastic endoprosthesis became bent in the duodenum and had to be removed endoscopically due to abdominal pain. None of the other endoprostheses lef t in the bowel caused any symptoms. Two patients died during the first week after the procedure due to progressive liver failure. Conclusion: Occluded bile duct endoprostheses can be safely dislodged to th e bowel and replaced by metallic stents using percutaneous interventional t echniques.