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The Interventional Radiology (IR) and Hepato Biliary (HPB) teams at University Hospitals Plymouth NHS Trust (UHP) have performed a rare procedure to help treat bile duct narrowing and remove stones.

The procedure, called IR Percutaneous Transhepatic Spyglass and Lithotripsy (PTCL), has only been performed a handful of times across the UK, making UHP one of the very few NHS Trusts to be able to offer this treatment.

Patients who may have had complex surgeries to remove part of their bile duct due to cancers or precancerous conditions, can experience a narrowing of the join between the bile duct and the bowel. This can lead to infections inside the liver and the formation of stones.

Narrowing of the bile ducts within the liver causes slow drainage of bile which leads to formation of stones within the bile ducts causing further narrowing and blockage. Previously when the traditional endoscopy treatment through the gut failed to place a stent in bile duct and clear the stones, the patients had to have major bile duct surgery or had lifelong drainage tube in liver. This leads to increased stays in hospital, repeated hospital visits, making the treatment journey more stressful for patients.

Now, the teams at UHP, led by HPB & Transplant Consultant Surgeon Mr Somaiah Aroori, Consultant Interventional Radiologist Dr Nelofer Gafoor and Interventional Radiology Fellow Dr Paul Jenkins, were able to offer a new form of treatment thanks to evolving equipment and skills. In this procedure, the bile duct was accessed through the liver and a thin spyglass endoscope was inserted into the ducts to break and clear the stones successfully. The bile duct narrowing was dilated at the same time.

Talking about the new procedure, HPB & Transplant Consultant Somaiah Aroori said: “The benefits for patients are enormous. There is no need for them to come for repeated procedures and the recovery time in hospital after the procedure is shorter than alternative treatments. There is also a reduced risk of infection during the procedure and recovery.

“The procedure also benefits the Trust. Now we have the equipment it can save on costs in the long run as there are no subsequent procedures to be done and as the recovery time is shorter, it allows us to treat more patients as beds will be free more often.”   

The surgery took place in September and was the result of few years of work from the teams to secure the necessary equipment and identify an appropriate patient. It took just under 2 hours and the patient was happy with the results, which saw all stones cleared and the narrowing stretched.

Feedback from the patient noted, “Throughout the process I have been involved with the objectives of the procedures and the probabilities and possibilities by Dr Gafoor and Dr Aroori. I was prepared in the theatre talking to team to the point where I could recognise faces and surroundings. This meant that I was totally relaxed and confident to the point of being part of the team.”

“After the procedure Dr Gafoor and Paul Jenkins came to the ward where Paul showed a clip of video entering the duct, the stones and then the equipment blasting the stones, it was amazing, and then I realised it was my body! I was very fortunate to be in right place at right time and I am pleased and proud to have been a part of this surgery.”

To stop a recurrence of the narrowing, the patient returned for an additional procedure where a special degradable stent was inserted. Previously, metal stents have been used, but it is hoped that this type of stent will dissolve after 2 to 3 months, and will can help the duct to stretch open successfully.

Reflecting on the success of the procedure, Somaiah said: “We kept the patient in hospital for a few extra days after the surgery to ensure that there were no issues, however the patient was very happy with the outcome and was pleased to be able to meet the team who operated on him after the procedure.”

The team subsequently performed similar procedure including insertion of biodegradable stent into the bile duct patient was discharged home the following day.

Consultant Radiologist Nelofer Gafoor said: “There is a lot of technological advancements involved in Interventional Radiology so there is always new equipment and new innovations to explore to offer patients’ the best treatment. “

“Sometimes it can take time to get the funding and approval for new kit, but now we have this equipment there’s lot of potential to do additional procedures and use new techniques. If we can continue to explore these innovative options, we will be able to help more patients and it will be beneficial for both services.”

 

Read more about the Interventional Radiology service at UHP here: https://www.plymouthhospitals.nhs.uk/interventional-radiology/

Find out more about the Hepato Biliary service at UHP here: https://www.plymouthhospitals.nhs.uk/hpb