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Non-endoscopic per oral biliary stent insertion

Department of Diagnostic Radiology, City General Hospital, London Road, Newcastle-under-Lyme, Staffordshire ST4 6QG, UK

This excerpt was created in the absence of an abstract.

We describe a new technique of biliary stent insertion which is particularly suitable for patients with previous gastric surgery where endoscopic or combined endoscopic and percutaneous biliary stent insertion would be technically difficult.

A 64-year-old lady with previous history of palliative polya gastrectomy for antral carcinoma presented with obstructive jaundice due to recurrent tumour. Under local anaesthesia and light sedation a percutaneous transhepatic approach was made into the dilated right intrahepatic biliary tree using a van Sonnenberg two part needle. A percutaneous transhepatic cholangiogram confirmed a dilated biliary tree, occlusion of the common bile duct and multiple stones in the gallbladder (Fig. 1). A hydrophilic guide wire (150 cm long, 0.035'' diameter, Radifocus angled type from Terumo Corporation, Tokyo) was manipulated through the occluded segment of the common bile duct into the proximal duodenal loop. A 110 cm long 5 F cobra catheter was inserted over the guide wire and was used to steer the guide wire through the gastro jejunal anastomosis into the stomach and thereafter through the gastro oesophageal junction into the oesophagus and mouth (Fig. 2).

Key Words: Polya gastrectomy • Obstructive jaundice • Cholangiogram • Biliary stricture • Biliary stent

Received for publication February 4, 1992. Revision received May 29, 1992. Accepted for publication June 22, 1992.