Percutaneous transhepatic cholangiography
- Stephan Anderson, MD
Stephan Anderson, MD
- Professor of Radiology
- Boston University School of Medicine
- Section Editors
- Sanjiv Chopra, MD, MACP
Sanjiv Chopra, MD, MACP
- Editor-in-Chief — Gastroenterology and Hepatology
- Section Editor — General Hepatology; Gallbladder and Biliary Tract Disease
- Professor of Medicine
- Harvard Medical School
- Senior Consultant in Hepatology
- James Tullis Firm Chief
- Beth Israel Deaconess Medical Center
- Jonathan B Kruskal, MD, PhD
Jonathan B Kruskal, MD, PhD
- Section Editor — Kidney Disease
- Professor of Radiology
- Harvard Medical School
Percutaneous transhepatic cholangiography (PTC) involves transhepatic insertion of a needle into a bile duct, followed by injection of contrast material to opacify the bile ducts. PTC is usually performed for evaluation of patients who are found to have biliary duct dilation on ultrasonography or other imaging tests and who are not candidates for endoscopic retrograde cholangiopancreatography (ERCP). Included in this group are patients who have surgically altered anatomy preventing endoscopic access to the biliary tree and those in whom ERCP was unsuccessful. PTC has close to 100 percent sensitivity and specificity for identifying the cause and site of biliary tract obstruction, being more accurate in this regard than ultrasonography or CT scan.
PTC also permits a number of therapeutic interventions, including drainage of infected bile in the setting of cholangitis, extraction of biliary tract stones, dilation of benign biliary strictures, or placement of a stent across a malignant stricture .
This topic will discuss the basic aspects of the technique of PTC and the complications that may be seen. The clinical utility of PTC in different disease states is discussed separately. (See "Treatment options for locally advanced cholangiocarcinoma" and "Acute cholangitis" and "Repair of common bile duct injuries" and "Treatment of advanced, unresectable gallbladder cancer", section on 'Palliation of obstructive jaundice' and "The role of endoscopy in biliary complications after liver transplantation".)
PTC is usually performed in patients with dilated bile ducts, which are easily recognized on transabdominal ultrasound or with all cross-sectional imaging modalities, including magnetic resonance cholangiopancreatography and computed tomography. These imaging studies are useful for planning the site of needle insertion during PTC, especially if the ductal dilation involves only one or a few liver segments. PTC may be technically limited and associated with a higher incidence of complications in the absence of dilatation of the intrahepatic ducts, although it has been performed successfully in some settings, such as in patients with postoperative biliary leaks [2-4].
Anesthesia — Since the percutaneous catheter traverses skin, intercostal muscles, and the liver capsule, the procedure can be painful and should be performed using local anesthesia and conscious sedation. Sedation is particularly important if additional procedures such as biopsy or stent insertion are planned. Some institutions prefer to use an intercostal nerve block, which may not reduce pain arising from puncture of the liver capsule or from intrahepatic manipulations. (See "Procedural sedation in adults outside the operating room".)
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