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Biliary Stenting


Over the past few decades, biliary interventions have evolved a great deal. Opacification of the biliary system was first reported in 1921 with direct puncture of the gallbladder. Subsequent reports described direct percutaneous biliary puncture. The technique was revolutionized in 1960s with the introduction of fine-gauge (22- to 23-gauge) needles.

During the 1970s, percutaneous biliary drainage (PBD) for obstructive jaundice and percutaneous treatment of stone disease was introduced. Percutaneous cholecystostomy was first described in the 1980s. With the advent of metallic and plastic internal stents, further applications in the treatment of biliary diseases were developed.

Current percutaneous biliary interventions include percutaneous transhepatic cholangiography (PTC) and biliary drainage to manage benign
and malignant obstruction and percutaneous cholecystostomy.
Percutaneous treatment of biliary stone disease, with or without choledochoscopy, is still performed in selected cases. Other applications include cholangioplasty for biliary strictures, biopsy of the biliary duct, and management of complications from laparoscopic cholecystectomy and liver transplantation.

Endoscopic ultrasonography (EUS)-guided biliary interventions are the subject of increasing interest (eg, in patients with unresectable distal biliary malignant obstruction who failed endoscopic retrograde cholangiography [ERCP]).

The Cardiovascular and Interventional Radiological Society of Europe (CIRSE) has published standards of practice for biliary stenting.

This article outlines the procedure for biliary stenting. For descriptions of other biliary interventions, see Percutaneous Cholecystostomy, Percutaneous Cholangiography, and Percutaneous Biliary Drainage.

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