Percutaneous transhepatic cholangioscopy
- Hiroto Kita, MD, PhD
Hiroto Kita, MD, PhD
- Professor, Department of Medicine
- Teikyo University, Tokyo, Japan
Miniature intraductal endoscopes have an increasingly important role in the diagnosis and nonsurgical treatment of biliary diseases, complementing diagnostic imaging modalities such as computed tomography and magnetic resonance imaging by permitting direct visualization of the biliary tree.
Intraductal endoscopes can be used intraoperatively and during endoscopic retrograde cholangiopancreatography. In addition, intraductal endoscopes may be introduced into the biliary tree via a percutaneous transhepatic approach.
This topic will review percutaneous transhepatic cholangioscopy, which is most commonly used when anatomic considerations prohibit a peroral approach (eg, after previous Roux-en-Y gastric bypass surgery) [1,2]. Percutaneous transhepatic cholangiography and peroral cholangioscopy and pancreatoscopy are discussed separately. (See "Percutaneous transhepatic cholangiography" and "Cholangioscopy and pancreatoscopy".)
The first step in percutaneous transhepatic cholangioscopy (PTCS) is the creation of a cutaneobiliary fistula. Percutaneous access to the biliary tree is typically obtained by invasive radiology under ultrasound and fluoroscopic guidance. Once the fistula tract matures, usually after 7 to 10 days, and has been sequentially dilated to at least 12 to 16 French, PTCS can be performed (picture 1) [3,4].
PTCS is time-consuming (procedures can take up to 90 minutes) and requires a well-trained team of an endoscopist and/or invasive radiologist skilled in this exam along with assisting technicians. Thus, it is only available in relatively few tertiary referral centers worldwide.
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