Percutaneous and Endoscopic Management of Biliary Obstruction

Abstract

Percutaneous radiological techniques are useful in the assessment and therapy of jaundiced patients. After initial evaluation using noninvasive methods such as ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), or radionuclide imaging, most patients with evidence of biliary obstruction require direct cholangiography by percutaneous transhepatic cholangiography (PTC) or endoscopic retrograde cholangiography (ERC) to establish the underlying cause. With either technique, once a diagnosis of biliary obstruction and its cause has been established, the obstruction can be relieved during the same procedure. The choice between percutaneous and endoscopic cholangiography usually depends to a large extent on local availability. In most institutions, ERC is the modality first used. PTC is performed when endoscopic expertise is unavailable, or when ERC is unsuccessful. PTC is also useful when the biliary tree is insufficiently demonstrated by ERC, which commonly occurs with obstruction at the liver hilum (Ferrucci et al. 1980; Cowling and Adam 2001). MR cholangiography is emerging as an excellent noninvasive test for the initial evaluation of patients with biliary obstruction. In a few centers, MRI has replaced direct methods of cholangiography in the investigation of biliary obstruction (Little et al. 1999; Funaki et al. 2000; Soto et al. 2000; Pavone et al. 1999).KeywordsBile DuctBiliary DrainageBiliary ObstructionMetal StentsMetallic StentsThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.