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Clinics and Research in Hepatology and Gastroenterology
Volume 43, n° 2
pages e9-e11 (avril 2019)
Doi : 10.1016/j.clinre.2018.03.010

Antegrade papillotome navigation as a novel next-line approach for internalization of percutaneous transhepatic biliary drainage

V. Zimmer a, b,
a Department of Medicine, Marienhausklinik St. Josef Kohlhof, 66539 Neunkirchen, Germany 
b Department of Medicine II, Saarland University Medical Center, Saarland University, 66421 Homburg, Germany 

CorrespondanceDepartment of Medicine, Marienhausklinik St. Josef Kohlhof, Klinikweg 1–5, 66539 Neunkirchen, Germany

There is an increasing rivalry between percutaneous transhepatic (PTBD) vs. endoscopic ultrasound-guided biliary drainage (EUS-BD) as rescue techniques after failed endoscopic retrograde cholangiography (ERC) access. While EUS-BD procedures hold a bright future, innovations in PTBD technique are still possible and clinically meaningful, at least so, under the a conceptual framework understanding PTBD as a bridging, anatomy-respecting technology for definitive biliary metal stenting. This, however, calls for successful PTBD internalization as a sine qua non. Against this background, here, I present a novel approach of PTBD internalization using a standard triple-lumen papillotome as a stiff catheter for probing and assisting in guidewire cannulation of the route to the duodenum. This is the first report on such re-purposed use of a papillotome, which may be instrumental in fine-tuning contrast media filling and crossing angulations within the biliary system. Taken together, innovative advancements and variations in PTBD technique, such as the presented “antegrade papillotome navigation ”, may rescue difficult PTBD internalization and, thus, potentially obviate the need for alternative approaches, including pure EUS-BD or even more complex hybrid PTBD-EUS procedures.

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Keywords : Bile duct obstruction, Endoscopic retrograde cholangiopancreatography, Interventional radiology

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