Over a 5-year period attempts at transhepatic introduction of a biliary endoprosthesis were made in 39 inoperable patients. The procedure was in 3 stages: transhepatic cholangiography, passage through the stenosis and positioning of the prosthesis. Stenosis was intrapancreatic in 20 cases, pedicular in 9 cases and hilar in 10 cases. The endoprosthesis was successfully set in 20 cases (51%), the success rate being related to the level of the obstacle: intrahepatic 60%, hilar 30%. Failure was more frequent in patients with right liver metastasis, cholangitis or prior unsuccessful palliative surgery. The prosthesis was effective for 1 month in 17 patients and for 6 months or more in 7 patients, two of whom were followed up for 14 and 18 months respectively. Provided patients are better selected and the procedure is used mainly for cholangiocarcinomas, we see no reason why the transhepatic route (combined, if necessary, with endoscopy) should no longer be used to introduce biliary endoprostheses.
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