Learning objectives
1.To review indications of interventional procedures in malignant biliary strictures 2.To describe the spectrum of techniques available, and set out the appropriate technique in the different clinical scenarios. 3.To recognize and manage the different complications that may occur.
Background
Biliary tumors, liver neoplasms, pancreatic carcinoma and lymphadenopathies, can obstruct the biliary tract. Biliary tract obstruction leads to clinical symptoms (pain, jaundice, pruritus) and liver damage. In case of impossibility or delay in effectiveness of a curable treatment, biliary drainage is recommended in order to palliating biliary obstruction symptoms. Biliary drainage can be performed with different techniques: surgical, endoscopic and interventional radiology techniques. Nowadays, most patients are managed by endoscopic techniques, therapeutic endoscopic retrograde cholangiopancreatography (ERCP), is the main therapeutic approach to perform biliary drainage, but in some situations such as failure in endoscopic drainage or altered anatomy of the upper gastrointestinal tract (anatomy variations or changes secondary to surgery), biliary drainage with interventional radiology techniques is necessary.
Imaging findings OR Procedure details
The radiology techniques available are: -External Biliary drainage: It involves leaving a catheter in the biliary tree above the level of obstruction. -Internal/External Biliary Drainage. It involves leaving a catheter in the biliary tree below the level of obstruction, so bile can drain through the catheter, as well as through the catheter side holes above and below the obstruction. -Biliary stents (metal or plastic). Stents can be placed at the level of obstruction and de-obstruct the stenosis.
Conclusion
Interventional radiology techniques constitute a good alternative option for biliary drainage in selected patients with Malignant biliary strictures.