Over the past few decades, biliary interventions have evolved a great deal. Opacification of the biliary system was first reported in 1921 with direct puncture of the gallbladder. Subsequent reports described direct percutaneous biliary puncture. The technique was revolutionized in 1960s with the introduction of fine-gauge (22- to 23-gauge) needles.
During the 1970s, percutaneous biliary drainage (PBD) forobstructive jaundiceand percutaneous treatment of stone disease was introduced. Percutaneous cholecystostomy was first described in the 1980s. With the advent of metallic and plastic internal stents, further applications in the treatment of biliary diseases were developed.
Current percutaneous biliary interventions include percutaneous transhepatic cholangiography (PTC) [1] and biliary drainage to manage benign [2, 3, 4] and malignant obstruction, as well aspercutaneous cholecystostomy. [5] Percutaneous treatment of biliary stone disease with or without choledochoscopy is still performed in selected cases. Other applications include cholangioplasty for biliary strictures, biopsy of the biliary duct, and management of complications fromlaparoscopic cholecystectomyandliver transplantation. [6, 7, 8]
Common causes of benign biliary obstruction include bile duct stones,strictures,sclerosing cholangitis,iatrogenic conditions, inflammatory processes (eg, pancreatitis), and infections (eg, HIV infection, parasitic cholangitis, and recurrent pyogenic cholangitis). Common malignant causes of biliary obstruction include pancreatic carcinoma,cholangiocarcinoma,and metastatic disease. Other causes of biliary obstruction includeCaroli disease,Mirizzi syndrome,retroperitoneal fibrosis,ampullary carcinoma,and gallbladder carcinoma.
Standards of practice for PTC have been published by the Cardiovascular and Interventional Radiological Society of Europe (CIRSE). [9]
This article outlines the procedure for percutaneous cholangiography. For descriptions of other biliary interventions, seePercutaneous Cholecystostomy,Percutaneous Biliary Drainage, andBiliary Stenting.
FAQs
Percutaneous transhepatic technique
This happens in 3% of the cases post surgical management of biliary stones. This procedure is contraindicated if T-tube is too small (less than 12 French in size), tortous T tube in tissues, acute pancreatitis, and when there is another drain that is connected to the T-tube tract.
What are the indications for PTC procedure? ›
PTC is indicated if there is an inaccessible papilla (eg, in ampullary carcinoma or duodenal obstruction from malignancy). Other indications for PTC include the management of postoperative or posttraumatic bile leakage.
What are contra indications for PTBD? ›
Some patients with obstruction in the bile duct system may not be eligible for the percutaneous transhepatic biliary drainage (PTBD) for several reasons, such as prolong coagulation, sepsis, massive ascites, cancer that has spread to the liver and multiple blockages in the bile duct system.
What are the contraindications to PTC and how do they influence patients' selection for the procedure? ›
Coagulopathy or bleeding disorders: PTC involves the insertion of a needle into the liver to access the bile ducts, which can lead to bleeding. Patients with coagulopathies or other bleeding disorders are at increased risk of hemorrhage during the procedure.
What are the indications for cholangiography? ›
Percutaneous cholangiography is an essential adjunct to diagnosing and treating patients with biliary disease. Patients who present clinically with jaundice or symptoms of obstructive biliary disease should be considered for ERCP and/or percutaneous cholangiography, depending on the clinical presentation.
What are the contraindications for percutaneous biliary stenting? ›
Contraindications of this procedure are as the followings: (1) Patients with poor systemic status, such as serious coagulation disorder; (2) Ascites, a relative contraindications; (3) Patients with a wide range of intrahepatic bile duct stricture; (4) Patients with severe stenosis of the portal vein adjacent to the ...
When should a PTC be performed? ›
Most of the time, this test is done after an endoscopic retrograde cholangiopancreatography (ERCP) test has been tried first. The PTC may be done if an ERCP test cannot be performed or has failed to clear the blockage.
What is a percutaneous transhepatic cholangiography used for? ›
Percutaneous transhepatic cholangiography is done when your child has or is suspected to have narrowing or blockage of the bile ducts draining the liver and the site and nature of the blockage needs to be determined for medical care.
Is PTC procedure painful? ›
They put a long thin needle through the skin and into the liver and bile ducts. They use ultrasound or x-rays to help guide the needle. You may feel some discomfort when the needle goes into the liver. Tell your doctor or nurse if you have any pain.
What is the survival rate of PTBD? ›
The overall median survival time following PTBD was 185 days (95% CI, 159–211 days). The 6-month and 1-year survival rates were 43 and 14%, respectively.
The reported complication rates of PTBD are between 3% and 10%, and these complications range from minor (e.g., access site pain) to death. Bleeding is one of the complications of PTBD.
What are the contraindications for percutaneous drainage? ›
Contraindications
- Uncorrectable coagulopathy.
- Lack of safe percutaneous access.
- If the patient cannot cooperate with the procedure.
- Inability to obtain the correct consent to perform the procedure with proper patient insight.
Your drain will usually be in place for at least 6 weeks. This will help to prevent any bile leaking from your gallbladder once the drain is removed. In some cases it may be necessary to have the drain for a longer period or until the date of surgery to remove the gallbladder.
How long is a PTC procedure? ›
The procedure time can vary depending on what is being done. A PTC alone usually takes from 30 minutes to 1 hour. Biliary dilatation/stenting takes from 45 minutes to 1 hour 30 minutes.
What to do before the PTC? ›
Doctors will ask you not to eat or drink for a few hours before a PTC. To help prevent infection, you will take antibiotics before and after the PTC. You will have the procedure in the x-ray department. A doctor called a radiologist will do the procedure.
What are the contraindications for percutaneous biliary drainage? ›
What are the relative contraindications for a biliary drainage?
- Allergy to iodinated contrast material.
- Large volume ascites (may require drainage before the procedure).
- Multifocal segmental biliary obstruction (e.g. caused by multiple liver metastases-biliary drainage may be ineffective).
Indications of percutaneous cholecystostomy
- Failure to improve after medical treatment.
- Severe sepsis or systemic inflammatory response syndrome.
- Advanced age.
- Gallbladder empyema.
- Refusing surgery.
- Suspected necrosis or perforation of gallbladder.
- Use of systemic anticoagulation.
- Late presentation [15–20].
The most common reason for having a PTBD is blockage of the drainage system of the liver, called the bile ducts. When this happens, the bile which normally drains down a narrow muscular passage, called the common bile duct, into the duodenum is backed up and the bile ducts in the liver become dilated.
What are the indications for selective cholangiography? ›
The indications for selective intraoperative cholangiography (IOC) include a clinical history of jaundice, pancreatitis, elevated bilirubin level, abnormal liver function test results, increased amylase levels, a high lipase level, or dilated common bile duct on preoperative ultrasonography.
