Transhepatic cholangiography in patients with suspected biliary disease and nondilated intrahepatic bile ducts

Abstract

Transhepatic cholangiography (THC) was performed in 107 patients who had nondilated intrahepatic bile ducts on computed tomography (CT) or ultrasound. The cholangiogram was diagnostic in 72 patients (67%). Thirty-one (43%) of the 72 diagnostic studies were abnormal and showed poor emptying, stones, or strictures. Twenty-three (21%) complications occurred, including two deaths. Sixteen patients experienced acute pain, requiring additional narcotics. There was one case of peritonitis and pancreatitis, and two of bacteremia. We compared our success and complication rates to those of endoscopic retrograde cholangiography (ERC) reported in the literature. We conclude that when a bile duct abnormality is clinically suspected, the incidence of pathology is sufficiently high to warrant direct visualization of the ducts in order to make an anatomic diagnosis, even if the intrahepatic ducts are not dilated. However, ERC has a better success rate and fewer complications than THC and it should be the initial invasive procedure.

Utility of the Short Double-Balloon Enteroscope to Perform Pancreaticobiliary Interventions in Patients with Surgically Altered Anatomy in a US Multicenter Study

“…In the past, patients with altered anatomy and a failed conventional ERCP have been referred for surgical or percutaneous interventions which are associated with greater morbidity and cost compared to ERCP [12]. Percutaneous transhepatic cholangiography (PTC) has several technical limitations, including patients with ascites and coagulopathy and those with non-dilated biliary ducts.…”

Diagnostic and Therapeutic Endoscopic Retrograde Cholangiography Using a Short-Type Double-Balloon Endoscope in Patients With Altered Gastrointestinal Anatomy: A Multicenter Prospective Study in Japan

“…Consequently, more invasive procedures, such as percutaneous interventions and open surgery, have been selected as primary treatments for biliary disease in these patients ( 4 ). However, the application of percutaneous transhepatic biliary drainage is limited by factors such as anticoagulant use and the presence of intrahepatic biliary dilatation or ascites ( 5 ), and open surgery is highly invasive.…”

Percutaneous Transhepatic Biliary Drainage in Patients with Postsurgical Bile Leakage and Nondilated Intrahepatic Bile Ducts

“…The endoscopic approach via endoscopic retrograde cholangiopancreatography (ERCP) is the first choice [6,13,14,15,16]. When ERCP is not successful or not feasible, percutaneous transhepatic biliary drainage (PTBD) becomes an alternative.…”

“…The first clinical studies on accessing nondilated bile ducts for percutaneous transhepatic cholangiography (PTC) reported a 25% technical success rate and a 21% complication rate [15,18]. More recent small series have shown that PTC and subsequent drainage for a variety of indications can be feasible in patients with nondilated bile ducts as well; the technical success rates were similar to those in patients with dilated bile ducts (91-100%) [17,19,20,21,22,23,24,25,26].…”