Experience with percutaneous transhepatic cholangioscopy (PTCS) in the management of biliary tract disease

Background: Biliary tract disorders often present significant management di fficulties, particularly in patients who are poop surgical candidates. Perc utaneous transhepatic cholangioscopy (PTCS) is an infrequently utilized alt ernative that might offer significant therapeutic benefit. We reviewed our experience with the use of this modality as a definitive therapy for biliar y tract disorders, Methods. Patient records at the Atlanta VAMC and Emery University hospitals were reviewed. We identified 17 patients who had undergone 25 PTCS interve ntions between August 1994 and December 1998. The indications for PTCS incl uded dilatation of biliary-enteric anastomoses in four patients, biliary st one removal (with or without lithotripsy) in eight patients, stricturoplast y 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 wer e <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, se ven of seven biopsies, and the single clot removal. The only complication i nvolved one episode of hemobilia, requiring angio-embolization of a small b ranch 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 t ract, and may allow avoidance of operation in high-risk surgical candidates .