Les complications du drainage biliaire interne endoscopique
Complications of internal endoscopic biliary drainage
After using 5, 6 and 7 French endoprostheses with a 40 % complication rate, it was possible from 1981 onwards to insert large calibre prothesis with the 3.7 and then with the 4.2 mm wide channel Olympus duodenoscope.
This study consists of 94 patients treated on the one hand with 10 Fr Amsterdam type Surgimed endoprostheses and, on the other hand with 9 French Biotrol endoprostheses. 29 patients were recently treated with 10 French Biotrol endoprostheses, the characteristics of which (shape, internal diameter, side holes) being improved by clinical and in vitro studies.
Our 94 patients include cases of pancreatic carcinoma (36 cases), cholangiocarcinoma (20 cases), carcinoma of the gallbladder (16 cases), metastasis from other sources (13 cases), and tumoral relapse after duodeno-pancreatectomy (1 case). There were only 8 cases of benign strictures.
The average survival rate was 134 days (3–450) and varied with the level of the stricture. Cholangitis was the main early complication. Late complications were clogging of the endoprosthesis, its dislodgement, acute cholecystitis, intra-hepatic abscesses, pancreatic abscess and fracture of the endoprosthesis. Analysis of internal biliary drainage results and experience of the different complications as well as experimental in vitro studies has enabled us to define optimal characteristics for biliary endoprostheses and outline a rational therapy when complications arise.
J. DEVIÉRE, M. BAIZE, M. BUSET, G. COSTAMAGNA, J. DE TCEUF, A. VAN GOSSUM, M. CREMER
drainage biliaire interne, complications, ictère néoplasique
endoscopic biliary drainage, complications, malignant jaundice