title: The role of percutaneous transhepatic cholangioscopy in patients with hilar strictures.
abstract: OBJECTIVE
  Various diagnostic advantages of percutaneous transhepatic cholangioscopy (PTCS) for the determination of the range of tumor and for the characterization of cholangioscopic findings have been reported. The aim of our study is to evaluate the diagnostic and therapeutic role of PTCS in patients with hilar strictures and to investigate its causes.
  
  
  METHODS
  We retrospectively studied the medical records and cholangioscopic reports of 177 patients who received PTCS for hilar strictures between January 2000 and December 2005 at Asan Medical Center, Seoul. For each patient, cholagnioscopy, biopsy result, computed tomography (CT) and magnetic resonance cholangiopancreaticography (MRCP), operation, and pathologic reports were collected.
  
  
  RESULTS
  Most patients had malignant hilar strictures or biliary papillomatosis while a few had benign hilar strictures. Presence of tumor vessel on PTCS was a useful diagnostic tool since direct observation of the tumor vessel strongly suggested a malignant tumor in the bile duct. The sensitivity of tumor vessel alone was 56.1%, and sensitivity of PTCS biopsy alone was 76.9%. However, sensitivity of biopsy combined with cholangioscopy of the tumor vessel was 88.4%, which was statistically significant compared with biopsy or tumor vessel alone.
  
  
  CONCLUSIONS
  PTCS biopsy combined with cholangioscopic observation was useful in differential diagnosis of hilar strictures. PTCS also had a therapeutic role in some patients with incurable malignant hilar lesion.
authors.affiliation: Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Ju Young
authors.initials: JY
authors.lastname: Jung
authors.forename: Sung Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Hyoung-Chul
authors.initials: HC
authors.lastname: Oh
authors.forename: Tae-Yoon
authors.initials: TY
authors.lastname: Lee
authors.forename: Seung Hyun
authors.initials: SH
authors.lastname: Kwon
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Dong Wan
authors.initials: DW
authors.lastname: Seo
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim