The benefits and risks of percutaneous transhepatic cholangioscopy

Abstract

Percutaneous transhepatic cholangioscopy (PTCS) was undertaken in 101 patients (for diagnostic reasons in 64 and/or therapeutic reasons in 56) out of 167 consecutive patients (56 women, 45 men; mean age 64.2 [27-95] years) in whom percutaneous transhepatic drainage had been instituted. In all but one of 64 patients PTCS clearly defined stenoses which had been unclear in the cholangiogram. There was a 90% accuracy of histological diagnosis of biopsies obtained under vision in 60 cases. A malignant stenosis was seen in 19 of 25 cases (sensitivity 76%). Severe stenosis, not passable by contrast medium, were recanalized cholangioscopically in 14 of 15 cases. Biliary tract stones were completely removed by PTCS in 40 of 41 patients, by mechanical means (n = 4) or intracorporeal lithotripsy (n = 37). There were no complications from PTCS. It is concluded that PTCS can be performed safely and reliably in patients with functioning percutaneous transhepatic drainage. It provides the diagnosis of previously unclear cholangiographic findings as well as treatment of difficult biliary tract stenoses and/or ductal stones.