Repositioning of percutaneous biliary endoprosthesis with transendoscopic balloon catheters.

Percutaneous placement of a permanent internal biliary prosthesis is now an established means of palliating inoperable malignant biliary tract obstruction or benign strictures in poor risk patients (Pereiras et al, 1978; Burcharth et al, 1981; Dooley et al, 1981). Though prosthesis design and dimensions may be important (Hoevels & Ihse, 1979), optimal biliary decompression primarily depends on accurate initial positioning relative to the stricture site and long-term maintenance of the intended position (Honickman et al, 1982). Dislocation after insertion is an important cause of prosthesis failure and has been reported in 4% (Burcharth et al, 1981) to 40% (Hoevels & Ihse, 1979) of patients. Proximal migration at the time of the primary procedure is easily corrected by pushing the prosthesis distally over the guide wire. Delayed proximal dislocation is a more complex problem, especially when there is associated blockage of the prosthesis. Percutaneous reinsertion of the initial coaxial “pusher” system thro...