Percutaneous transhepatic cholangiography
| Percutaneous transhepatic cholangiography | |
|---|---|
 Percutaneous transhepatic cholangiography | |
| Other names | Percutaneous hepatic cholangiogram |
| ICD-9-CM | 87.51 |
| OPS-301 code | 3-13c.1 |
Percutaneous transhepatic cholangiography (PTHC or PTC), percutaneous hepatic cholangiogram, or percutaneous transhepatic cholangiography and drainage (PTCD) is a radiological technique used to visualize the anatomy of the biliary tract. A contrast medium is injected into a bile duct in the liver, after which X-rays are taken. It allows access to the biliary tree in cases where endoscopic retrograde cholangiopancreatography (ERCP) has been unsuccessful. Initially reported in 1937, the procedure became popular in 1952.[1][2]
Technique
It is predominantly now performed as a therapeutic technique. There are less invasive means of imaging the biliary tree including transabdominal ultrasound, magnetic resonance cholangiopancreatography, computed tomography and endoscopic ultrasound. If the biliary system is obstructed, PTC may be used to perform biliary drainage until a more permanent solution for the obstruction is performed (e.g. surgery). Additionally, self expanding metal stents can be placed across malignant biliary strictures to allow palliative drainage. Percutaneous placement of metal stents can be utilised when therapeutic ERCP has been unsuccessful, anatomy is altered precluding endoscopic access to the duodenum, or where there has been separation of the segmental biliary drainage of the liver, allowing more selective placement of metal stents.
Cholangiography during a biliary drainage intervention is called perioperative or primary choloangiography, and when performed later in the same drain it is called secondary cholangiography.[3]
Indications
Cholestatic jaundice, to exclude extra hepatic bile duct obstruction, prior to biliary drainage procedure.
If ERCP is failed and/or there is an obstruction in the proximal billiary tree
Contraindications
- Bleeding tendency
- Biliary tract sepsis
- Being unfit for surgery
- Hydatid cysts
- Ascites
- CLD (Chronic liver disease)
Complications
PTBD may increase the incidence of metastasis, tube dislocation, and bleeding when compared to endoscopic biliary drainage (EBD). However, PTBD has lower rate of cholangitis, pancreatitis when compared to EBD, probably because EBD has higher chance of incomplete drainage of infected bile, or accidental resection of papilla that causes the backflow of infected bile from the duodenum into the biliary system.[4]
References
- ^ Carter RF, Saypol GM (1952). "Transabdominal cholangiography". Journal of the American Medical Association. 148 (4): 253–5. doi:10.1001/jama.1952.02930040009002. PMID 14888454.
- ^ Atkinson M, Happey MG, Smiddy FG (1960). "Percutaneous transhepatic cholangiography". Gut. 1 (4): 357–65. doi:10.1136/gut.1.4.357. PMC 1413224. PMID 13684978.
- ^ Schuberth, O. O.; Sjogren, S. E. (2010). "On Cholangiography". Acta Radiologica. 22 (5–6): 780–795. doi:10.3109/00016924109136457. ISSN 0001-6926.
- ^ Duan, Feng; Cui, Li; Bai, Yanhua; Li, Xiaohui; Yan, Jieyu; Liu, Xuan (2017-12). "Comparison of efficacy and complications of endoscopic and percutaneous biliary drainage in malignant obstructive jaundice: a systematic review and meta-analysis". Cancer Imaging. 17 (1): 27. doi:10.1186/s40644-017-0129-1. ISSN 1470-7330. PMC 5644169. PMID 29037223.
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External links
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