A combined radiologic and endoscopic approach to removal of occluded double-mushroom biliary endoprosthesis: technical note

Displacement of Endoscopically Placed Plastic Biliary Endoprostheses into the Duodenum with a Simple Transhepatic Technique

The authors to describe the technique and report the results of percutaneous displacement of endoscopically placed plastic biliary endoprostheses into the duodenum at the time of transhepatic intervention in 34 patients. Displacement into the duodenum was effected by simply passing a guide wire through the stent, and then pushing it into the gut with a catheter. Thirty-three of 36 stents (92%) were successfully displaced in this manner. No complications related to stent passage out of the gastrointestinal tract were encountered. Plastic biliary stents can be safely displaced into the duodenum when patients undergo transhepatic biliary procedures, thus avoiding repeated endoscopy.

Transnasal removal of a biliary endoprosthesis with percutaneous transhepatic biliary catheter replacement

The authors describe a novel fluoroscopically guided transnasal technique for removal of an endoscopically placed endobiliary prosthesis (EBP). A case in which the approach was applied is used to demonstrate its indications, clinical utility and possible benefits. The procedure entails simultaneous percutaneous replacement of the EBP with an internal/external biliary catheter over a through-and-through transhepatic/transnasal access wire. A comparison of the technique's limitations with those of traditional approaches for endoscopic or percutaneous EBP removal and replacement is presented.