The role of percutaneous transhepatic cholangioscopy in patients with hilar strictures.
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.
Jung
Ju Young
JY
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Lee
Sung Koo
SK
Oh
Hyoung-Chul
HC
Lee
Tae-Yoon
TY
Kwon
Seung Hyun
SH
Lee
Sang Soo
SS
Seo
Dong Wan
DW
Kim
Myung-Hwan
MH