Percutaneous transhepatic cholangiography

The combined experience of the authors is presented in review form. Indications, contraindications and technics of percutaneous transhepatic cholangiography are presented. Salient points of radiographic interpretation are illustrated with representative cases of biliary lithiasis, neoplastic disease of the pancreas, ampulla of Vater, gallbladder and hepatic hilus. The important role of percutaneous transhepatic cholangiography in the management of jaundiced patients is discussed.     

Percutaneous transhepatic cholangiography

Percutaneous transhepatic cholangiography was attempted on 102 occasions at the Ochsner Foundation Hospital from 1952 to 1972. The biliary system was demonstrated in 80 (78%) patients and biliary ducts were dilated in 73 (72%). Percutaneous cholangiography was successful in 68 (93%). Complications occurred in 7 (7%) patients; there were no deaths. Of 1629 procedures reported in the literature, 74% were successful; there were only 4 deaths (0.25%) and 82 complications (5%).     

Percutaneous transhepatic cholangiography

Summary 1. Percutaneous transhepatic cholangiography should take its proper place in our armamentarium of diagnostic procedures.2. If one adheres strictly to the indications and observes careful technic, the hazards are minimal and the information gained rewarding, as illustrated by a detailed report of 1 case.3. It is suggested that this procedure might be utilized at the operating table in place of the retrograde cholangiogram.     

Chiba needle percutaneous transhepatic cholangiography

Percutaneous transhepatic cholangiography with the Chiba University needle has been utilized in 30 patients. The ducts were successfully demonstrated in all 21 patients with obstructive jaundice. Sixty-seven percent of normal or stenosed ducts were visualized. No serious complications occurred and emergency post-procedural laparotomy was unnecessary. Our results reflect other reports. Percutaneous transhepatic cholangiography is an efficacious method of evaluating the hepatobiliary system.     

Interventional EUS cholangiography: A report of five cases

BACKGROUND: ERCP may be unsuccessful because of the presence of a complex peripapillary diverticulum, prior surgery, obstructing tumor, papillary stenosis, or impacted stones. Percutaneous transhepatic cholangiography is a classic technique for accessing the bile duct and remains the primary alternative when biliary ERCP is unsuccessful. With the evolution of interventional EUS, additional options are available for management of biliary obstruction. METHODS: EUS cholangiography was performed, after which the puncture was enlarged to form an enterocholedochal fistula that was used for interventions that resulted in biliary decompression in 5 patients with obstructive jaundice. OBSERVATIONS: Cholangiography was readily performed in all 5 patients. In one patient, a guidewire could not be manipulated across the papilla via the enterocholedochal fistula, necessitating percutaneous intervention. Biliary decompression was achieved in the other 4 patients, in the last two, as a single procedure. CONCLUSIONS: Interventional EUS cholangiography is a new technique that allows drainage of a dilated biliary system when the bile duct is inaccessible by conventional ERCP.     

Percutaneous transhepatic cholangiography: Its use and limitations

Summary and conclusions A review of accumulated experience with 423 attempts at percutaneous transhepatic cholangiography verifies the usefulness of this procedure in differentiating obstructive from non-obstructive jaundice.The procedure is not uniformly successful nor is it infallible. Failure to aspirate bile is not a completely reliable indication that posthepatic obstruction is not present. Conversely, aspiration of bile after introduction of the exploring needle or catheter, without obtaining a cholangiogram, should not be used as proof of extrahepatic obstruction.Although fatalities are rare, complications occur and percutaneous transhepatic cholangiography is not without risk, especially of bile peritonitis.Bile peritonitis may ensue even when the exploring catheter is left in situ. It would seem wiser and safer, therefore, to schedule operation within 4–8 hr. of transhepatic cholangiography when an obstructing lesion has been identified, or when the examination is unsuccessful and diagnosis is still obscure.The procedure would appear to be especially valuable in cases of jaundice in which the diagnosis is still in doubt after all other studies have been performed. However, the hazards attending its performance alone dictate that it not be used inall cases of obstructive jaundice.     

Unusual outcome of percutaneous transhepatic cholangiography.

In a 72-year old male with fever, mild jaundice and moderate enlargement of both liver and spleen, percutaneous transhepatic cholangiography resulted in direct filling of the portal vein system. Both trunc and left and right hepatic lobe branches showed a typical pattern of incomplete portal vein thrombosis, with mural irregularities and radiolucencies within the lumen. On subsequent operative cholangiography the biliary tract was shown to be normal. At autopsy multiple intrahepatic abscesses of pylephlebitic origin were found. The significance of visualization of the portal vein system during PTC is briefly discussed in comparison with other angiographic technics.     

PTC对胰胆管合流异常的诊断

目的:探讨经皮肝穿刺胆道造影(percutaneous transhepatic cholangiography,PTC)诊断胰胆管合流异常(pancreaticobiliary maljunction,PBM)的可行性,总结其影像学诊断特征.方法:回顾性分析1999-01/2007-02连续257例因阻塞性黄疸(obstructive jaundice,OJ)PTC下行介入治疗患者的临床及影像学资料,确立病例入选标准与PBM诊断参考标准,从中筛选出资料完整、胰管显影的病例35例,测量胆胰共同管长度和直径、汇合处胆胰管直径、汇合角度等,并经校正得到实际数值,结果经统计学处理.结果:PBM确诊31例,PTC检出率为12.06%.共同管长度为9.88±4.55 mm,明显高于正常长度标准(P＜0.05).十二指肠乳头位置影响共同管长度大小.汇合处胆总管直径、胰管直径、共同管直径分别为3.20±1.62 mm、2.06±0.82 mm和3.03±1.03 mm,与正常值比较无统计学差异.结论:PTC诊断PBM方法可行、安全、有效,PBM的PTC表现具有一定的特征性.     

EUS-guided rendezvous drainage of obstructed biliary and pancreatic ducts: Report of 6 cases

BACKGROUND: Only a few cases have been reported of EUS-guided drainage of obstructed pancreatic or bile ducts. An initial experience with EUS-guided rendezvous drainage after unsuccessful ERCP is reported. METHODS: EUS-guided transgastric or transduodenal needle puncture and guidewire placement through obstructed pancreatic (n=4) or bile (n=2) ducts was attempted in 6 patients. Efforts were made to advance the guidewire antegrade across the papilla or surgical anastomosis. If guidewire passage was successful, rendezvous ERCP with stent placement was performed immediately afterward. RESULTS: EUS-guided duct access and intraductal guidewire placement was accomplished in 5 of 6 cases, with successful traversal of the obstruction, and rendezvous ERCP, with stent placement in 3 of 6 cases (two biliary, one pancreatic). The procedure was clinically effective in all successful cases (two patients with malignant obstructive jaundice, one with relapsing pancreatitis after pancreaticoduodenectomy). There was one minor complication (transient fever) but no pancreatitis or duct leak after successful or unsuccessful procedures. CONCLUSIONS: EUS is a feasible technique for allowing rendezvous drainage of obstructed biliary or pancreatic ducts through native papillae or anastomoses after initially unsuccessful ERCP.