Percutaneous transhepatic cholangiography

Percutaneous transhepatic cholangiography (PTHC or PTC), percutaneous hepatic cholangiogram, or percutaneous transhepatic cholangiography and drainage (PTCD) is a radiological technique used to visualize the anatomy of the biliary tract. A contrast medium is injected into a bile duct in the liver, after which X-rays are taken. It allows access to the biliary tree in cases where endoscopic retrograde cholangiopancreatography (ERCP) has been unsuccessful. Initially reported in 1937, the procedure became popular in 1952.[1][2]

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Percutaneous transhepatic cholangiography
Percutaneous transhepatic cholangiography
Other namesPercutaneous hepatic cholangiogram
ICD-9-CM87.51
OPS-301 code3-13c.1

Technique

It is predominantly now performed as a therapeutic technique. There are less invasive means of imaging the biliary tree including transabdominal ultrasound, magnetic resonance cholangiopancreatography, computed tomography and endoscopic ultrasound. If the biliary system is obstructed, PTC may be used to perform biliary drainage until a more permanent solution for the obstruction is performed (e.g. surgery). Additionally, self expanding metal stents can be placed across malignant biliary strictures to allow palliative drainage. Percutaneous placement of metal stents can be utilised when therapeutic ERCP has been unsuccessful, anatomy is altered precluding endoscopic access to the duodenum, or where there has been separation of the segmental biliary drainage of the liver, allowing more selective placement of metal stents.

Cholangiography during a biliary drainage intervention is called perioperative or primary choloangiography, and when performed later in the same drain it is called secondary cholangiography.[3]

Indications

Cholestatic jaundice, to exclude extra hepatic bile duct obstruction, prior to biliary drainage procedure.

If ERCP is failed and/or there is an obstruction in the proximal billiary tree

Contraindications

Complications

It is generally accepted that percutaneous biliary procedures have similar complication rates to therapeutic ERCP. Complications encountered include infection, bleeding and bile leaks. (Duan, F., Cui, L., Bai, Y., Li, X., Yan, J., & Liu, X. (2017). Comparison of efficacy and complications of endoscopic and percutaneous biliary drainage in malignant obstructive jaundice: a systematic review and meta-analysis. Cancer Imaging, 17(1). doi:10.1186/s40644-017-0129-1)

References
  1. Carter RF, Saypol GM (1952). "Transabdominal cholangiography". Journal of the American Medical Association. 148 (4): 253–5. doi:10.1001/jama.1952.02930040009002. PMID 14888454.
  2. Atkinson M, Happey MG, Smiddy FG (1960). "Percutaneous transhepatic cholangiography". Gut. 1 (4): 357–65. doi:10.1136/gut.1.4.357. PMC 1413224. PMID 13684978.
  3. Schuberth, O. O.; Sjogren, S. E. (2010). "On Cholangiography". Acta Radiologica. 22 (5–6): 780–795. doi:10.3109/00016924109136457. ISSN 0001-6926.


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