Experience with percutaneous transhepatic cholangioscopy (PTCS) in the management of biliary tract disease.
BACKGROUND
Biliary tract disorders often present significant management difficulties, particularly in patients who are poor surgical candidates. Percutaneous transhepatic cholangioscopy (PTCS) is an infrequently utilized alternative that might offer significant therapeutic benefit. We reviewed our experience with the use of this modality as a definitive therapy for biliary tract disorders.


METHODS
Patient records at the Atlanta VAMC and Emory University hospitals were reviewed. We identified 17 patients who had undergone 25 PTCS interventions between August 1994 and December 1998. The indications for PTCS included dilatation of biliary-enteric anastomoses in four patients, biliary stone removal (with or without lithotripsy) in eight patients, stricturoplasty in four patients, biopsy of suspected biliary neoplasms in seven patients, and removal of obstructing clot in one patient. Most procedures (n = 17) were performed through percutaneous transhepatic tracts (12-18 Fr) that were <1 week old. All tracts were dilated to operating size on the day of the procedure. All patients received periprocedural antibiotics.


RESULTS
The interventions were successful in seven of eight stone removals, four of five stricturoplasties, three of four anastomotic dilatations, seven of seven biopsies, and the single clot removal. The only complication involved one episode of hemobilia, requiring angio-embolization of a small branch of the right hepatic artery.


CONCLUSIONS
PTCS is a safe, useful, and well-tolerated adjunct to the more common endoscopic and surgical techniques for managing complicated biliary tract disorders. Our experience suggests that PTCS can be performed early, without prolonged sequential dilatation of the percutaneous transhepatic tract, and may allow avoidance of operation in high-risk surgical candidates.
Simon
T
T
Department of Surgery, Emory University School of Medicine and Atlanta Veterans Administration Hospital, Atlanta, GA 30033, USA.
Fink
A S
AS
Zuckerman
A M
AM
D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000628:therapy*; D001706:Biopsy; D016145:Endoscopy, Digestive System / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies