Radiology, Vol 192, 241-246, Copyright © 1994 by Radiological Society of North America
Malignant biliary obstruction: preliminary results of palliative treatment with hepaticogastrostomy under fluoroscopic, endoscopic, and laparoscopic guidance
G Soulez, M Gagner, E Therasse, E Deslandres, A Pomp, R Leduc, EJ Bernard, O Prosmanne and P Robillard
Department of Radiology, Hotel-Dieu de Montreal, Quebec, Canada.
PURPOSE: To report a technique of peripheral biliary decompression by means
of anastomosis of a bile duct in segment II of the liver to the lesser
curvature of the stomach. MATERIALS AND METHODS: Seven patients with
unresectable biliary neoplasm were treated. After transhepatic
catheterization of a segment II bile duct, the left lobe of the liver and
the lesser curvature of the stomach were perforated under fluoroscopic and
laparoscopic guidance. Anastomosis between the biliary tree and the stomach
was maintained with a gastrostomy tube placed across the tract. After 2
weeks, the tube was removed and patency of the tract was preserved with a
metallic stent. RESULTS: Three patients died, at 3, 6, and 9 months,
respectively, without reocclusion; the other four were alive at 5 months
without jaundice. One patient had an episode of cholangitis, which was
resolved with antibiotic therapy. CONCLUSION: This method yields a good
patency rate with few problems. Further investigation is required to
evaluate long-term patency and the necessity of laparoscopic guidance.
