7097 Prospective evaluation of the safety of percutaneous transhepatic cholangioscopy.

Abstract

Percutaneous transhepatic cholangioscopy (PTCS) is a commonly used technique for patients with intrahepatic stones and various bile duct strictures, especially in Southeast Asia. However, the complications of the procedure have not been well described. AIMS: This study was performed to evaluate the safety of PTCS prospectively. METHODS: Two hundred and ninety-four consecutive patients (M:F=171:123, mean age: 59±12 yrs)who were intended to receive PTCS in our hospital because of intrahepatic stones (n=157) or strictures (n=137) were enrolled in this study. For PTCS, percutaneous transhepatic biliary drainage (PTBD)was first performed using a 7 to 8 Fr catheter and two or three days later, the tract was dilated up to 16 or 18 Fr.Seven to ten days later, PTCS was performed. The complications associated with PTBD, dilatation of the tract and PTCS were evaluated. Major bleeding was defined as bleeding that required transfusion or other therapeutic intervention. RESULTS: The most common two complications associated with PTBD (including tract dilatation) and PTCS were transient fever (32.3%) and pain (34.7%). Both were managed effectively by antibiotics and analgesics. Bleeding developed in 10.2% of patients after PTBD or PTCS and major bleeding developed in 1.4% of the patients. Such bleedings arose during dilatation of the percutaneous tract or stone removal and were controlled effectively by transarterial embolization except one operation. Sepsis developed in 9.9% of patients and managed by antibiotics and/or tube changes. Sinus tract rupture and peritonitis were noted in 1.7% and 0.7%, respectively. There was no procedure-related mortality. CONCLUSIONS: Transient fever and pain were the most frequent complications during PTBD and PTCS.With the appropriate use of antibiotics and analgesics, PTCS seems to be a safe procedure having low rate of major complication.