Transhepatic Cholangiography Research Articles

A New Biodegradable Stent to Improve the Management of Biliary Strictures in Pediatric Split Liver Transplantation.

Cholestasis due to benign biliary strictures is the most common biliary complication after pediatric split liver transplantation (SLT), decreasing graft survival, but consensus about its management lacks. Percutaneous transhepatic cholangiography, bilioplasty and internal-external biliary drainage (IEBD) are standard treatments. The aim of this report is to present the preliminary experience with a new biodegradable biliary stent in the management of post-SLT biliary strictures. Between September 2020 and April 2021, SLT patients with a single anastomotic benign biliary stricture underwent percutaneous transhepatic implantation of an innovative 10F helical-shaped biodegradable biliary stent, featuring a slow degradation profile, in addition to the standard treatment with bilioplasty and IEBD. The device is unique and the first to be CE-marked for the use in this indication. Six pediatric patients (4 males; median age 8.6years, interquartile range 3.7years)underwent percutaneous stent implantation, without complications nor clinical cholestasis during a median follow-up of 271days (IQR 120.25). Stent dislodgement occurred in one case. Preliminary data suggest that implantation of a new biodegradable biliary stent may be considered in the management of post-SLT cholestasis in pediatric patients. Some technical tips are useful during implantation. This device may prolong biliary drainage, potentially relieving the discomfort of long-term IEBD.

Transabdominal amnioinfusion: An evaluation of its adverse events

ObjectiveTransabdominal amnioinfusion is beneficial in oligohydramnios, which has high fetal mortality and does not improve with observation alone. However, there are few reports on the maternal adverse events of transabdominal amnioinfusion. This study aimed to evaluate the adverse events of amniocentesis with transabdominal amnioinfusion. Study designThis study is a retrospective cohort study at a single tertiary perinatal center in Japan. A total of 313 procedures in 126 patients who underwent amniocentesis for transabdominal amnioinfusion at our tertiary perinatal institution were evaluated using the Common Terminology Criteria for Adverse Events (CTCAE). Adverse events were retrospectively examined using a 5-grade evaluation based on the CTCAE. Procedurally, a 21–23-G percutaneous transhepatic cholangiography drainage (PTCD) needle was advanced under ultrasound guidance into the amniotic fluid cavity with a gravity-fed infusion of warm saline solution. ResultsNo maternal deaths were recorded. Only two maternal/fetal adverse events occurred, and grade 4 fetal adverse events requiring pregnancy termination were observed in seven cases. Fetal death occurred in five cases, all with severe oligohydramnios and premature rupture of the membranes. No placental abruption or bleeding occurred before or after delivery. ConclusionAdverse events during transabdominal amnioinfusion were successfully analyzed using CTCAE. We also provided new terminology for evaluating adverse events during amnioinfusion. Our results may encourage obstetricians to perform amnioinfusion in difficult situations, with less concern for severe maternal or fetal adverse events.

Biliary complications in pediatric liver transplantation: findings of percutaneous transhepatic cholangiography in a large single-center cohort.

Although biliary complications after orthotopic liver transplantation represent a common source of morbidity and mortality, decreasing graft survival, consensus is lacking on their management in the pediatric population. The aim of this study was to present the prevalence of such biliary complications and their interventional radiologic management with representative images. This retrospective study reports our experience with percutaneous transhepatic cholangiography in the management of biliary complications after orthotopic liver transplantation in pediatric patients. This study enrolled all pediatric patients (<18years old) who underwent percutaneous transhepatic cholangiography for the management of biliary complications after orthotopic liver transplantation at a tertiary care center between January 2010 and December 2020. Diagnosis of biliary complications and indication to perform percutaneous transhepatic cholangiography were based on clinical, laboratory or radiologic data. Among the 301 orthotopic liver transplantations, 78 (26%) developed biliary complications that were managed by interventional radiology: these included 52 (17.3%) biliary strictures, 19 (6.3%) bile leaks, 5 (1.7%) biliary stones, 1 (0.3%) iatrogenic biliary obstruction and 1 (0.3%) vanishing syndrome. The median time interval between orthotopic liver transplantation and the diagnosis of biliary complications was 6.0years (interquartile range [IQR] 8.2years). Percutaneous transhepatic cholangiography and biliary duct catheterization were successful in all cases, with low rates of complications that were variable among subgroups. A wide spectrum of biliary complications can occur after pediatric orthotopic liver transplantation. In this large single-center experience, we highlight the value of percutaneous transhepatic cholangiography in their diagnosis and management. Percutaneous treatments in pediatric patients are safe and effective, providing resolution or serving as a bridge to surgery, including re-transplantation.

The Effect of Palliative Invasive Interventions on Overall Survival in the Last 3 Months of Life in Metastatic Gastric Cancer.

Gastric cancer is one of the biologically aggressive and highly mortal cancers. In addition to limited treatment options, especially in advanced stages, palliative treatment methods are applied to increase patients' quality of life with gastric cancer. This study aims to discuss the effects of paracentesis, thoracentesis, tube thoracostomy, double J catheter nephrostomy, percutaneous transhepatic cholangiography (PTC), and abscess drainage catheter placement procedures applied in the last 3 months for problems requiring palliation, in the light of literature. The patient characteristics of the patients and, in addition, the history of any invasive intervention for palliative treatment in the last 3 months were questioned and recorded with the electronic medical record system. The effect of an invasive intervention on survival was examined. The data of patients with metastatic gastric cancer followed in the medical oncology clinic between February 2012 and May 2020 were reviewed retrospectively. In this study, in which the effect of palliative invasive intervention (PIG) stories on survival in the last 3 months of life of patients diagnosed with metastatic gastric cancer was examined, no significant difference was found between those who underwent PIG and those who did not, in terms of overall survival. However, since PIG was not included in the design of our study, the effect of PIG in terms of quality of life, mood, motivation of patient relatives, and the cost is unknown. In the final analysis, it was noted that 143 (94.1%) of the 152 patients included in the study died and 9 (5.9%) were still alive. Overall survival of all patients was reported as 12.9 months (95% CI, 10.9-14.9). The mean overall survival of 36 patients who underwent palliative invasive intervention (PIG) in the last 3 months was 13.0 months (95% CI, 9.1-17.0), and a similar 13.0 months (95% CI, 10.6-15.3) of 116 patients who did not undergo PIG no significant difference was found (p: 0.887).

Clinical features and treatment of hepatic abscesses with biloma formation after transcatheter arterial chemoembolization

Background and study aimsA full understanding of the clinical manifestations and risk factors for hepatic abscesses with biloma formation after transcatheter arterial chemoembolization (TACE) is crucial for accurate diagnosis and effective therapeutic intervention. Patients and methods11,524 patients with hepatic tumors were treated with TACE. 84 patients were diagnosed with hepatic abscesses after TACE, and 35 progressed to hepatic bilomas and were treated with percutaneous transhepatic drainage (PTD) and/or percutaneous transhepatic cholangiography and drainage (PTCD). Clinical features, blood samples, bacterial cultures, and imaging data were collected, and incidence, risk factors, therapeutic effects, and prognostic indicators were analyzed. ResultsThe incidence of biloma in patients with liver abscesses was 41.7% with an average diagnosis time of 12.3 ± 3.2 days. 71.4% of patients complained of abdominal pain, and 63.7% had metastatic liver cancer. In the latter patients, clinical features included multiple abscess lesions with a poor blood supply to the tumor and large necrotic lesions. The original tumors were primarily in the digestive system (87.0%). The mean diameter of the largest lesions was 6.5 ± 2.3 cm. Before abscess formation, the Child-Pugh liver function classification was grade A in 14 cases and grade B in 21 cases. Escherichia coli was the most frequently seen infectious bacteria. Liver function was significantly compromised by the occurrence of hepatic abscesses. The mean survival time after diagnosis of liver abscesses in all patients was 11.5 ± 0.6 months. The causes of death included abscess (n = 9, 25.7%), tumor (n = 22, 62.9%), and other causes (n = 4, 11.4%). Risk factors included tumors, gastrointestinal surgery, and diabetes. ConclusionPTD and/or PTCD combined with active antibiotics are recommended as the first-line treatment and are effective therapeutic regimens for biloma formation after TACE.

North American Biliary Stricture Management Strategies in Children After Liver Transplantation: A Multicenter Analysis From the Society of Pediatric Liver Transplantation (SPLIT) Registry.

Biliary strictures affect 4%-12% of pediatric liver transplantations. Biliary strictures can contribute to graft loss if left untreated; however, there remains no consensus on the best course of treatment. Study objectives included analyses of outcomes associated with biliary stricture management strategies via percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangiopancreatography (ERCP), or surgery. We identified pediatric liver transplantation recipients (2011-2016) with biliary strictures from the Society of Pediatric Liver Transplantation (SPLIT) registry and retrieved imaging, procedural, and operative reports from individual centers. Subanalyses were performed to specifically evaluate PTC and ERCP for "optimal biliary outcome" (OBO), defined as graft survival with stricture resolution and without recurrence or surgery. A total of 113 children with a median follow-up of 3.9years had strictures diagnosed 100days (interquartile range, 30-290) after liver transplantation; 81% were isolated anastomotic strictures. Stricture resolution was achieved in 92% within 101days, more frequently with isolated anastomotic strictures (96%). 20% of strictures recurred, more commonly in association with hepatic artery thrombosis (32%). Patient and graft survival at 1 and 3 years were 99% and 98% and 94% and 92%, respectively. In a subgroup analysis of 79 patients with extrahepatic strictures managed by PTC/ERCP, 59% achieved OBO following a median of 4 PTC, and 75% following a median of 3 ERCP (P<0.001). Among patients with OBO, those with ERCP had longer time intervals between successive procedures (41, 47, 54, 62, 71days) than for PTC (27, 31, 36, 41, 48days; P<0.001). Allograft salvage was successful across all interventions. Stricture resolution was achieved in 92%, with 20% risk of recurrence. Resolution without recurrence was highest in patients with isolated anastomotic strictures and without hepatic artery thrombosis.

Choledochoduodenostomy is associated with fewer post-transplant biliary complications compared to Roux-en-Y in primary sclerosing cholangitis patients.

For primary sclerosing cholangitis (PSC) patients undergoing liver transplantation (LT), a consensus regarding biliary reconstruction remains unresolved. Choledochoduodenostomy (CDD) represents an alternative to Roux-en-Y (RY) and duct-to-duct. We compared long-term post-transplant outcomes between CDD and RY. This was a retrospective review of patients transplanted for PSC who received CDD or RY, with minimum 12-months follow-up. The primary outcome was need for biliary intervention, with either percutaneous transhepatic cholangiography (PTC) or endoscopic retrograde cholangiopancreatography (ERCP). Secondary outcomes included biliary stricture(s) and cholangitis admission(s). Ninety-three patients were transplanted between August 2004 and October 2019 (34 living donor [LDLT] and 59 deceased donor [DDLT]; 40 RY, 53 CDD). Need for either ERCP or PTC was similar (45.0% RY vs. 32.1% CDD, P=.203), though RY exhibited more anastomotic strictures (AS) (35.0% RY vs. 11.3% CDD, P=.006), which was also observed in LDLT subanalyses (50.0% LDLT/RY vs. 10.0% LDLT/CDD; P=.036). Cholangitis admissions were more frequent in RY versus CDD (37.5%vs. 15.1%, P=.013). CDD does not impart greater risk of biliary complications, and RY may have an incremental effect combined with LDLT status for predisposing to AS. CDD maintains standard endoscopic access without additional risk of biliary complications, thus should be considered when anatomically feasible.

Commentary on “CIRSE Standards of Practice on Percutaneous Transhepatic Cholangiography, Biliary Drainage and Stenting”: Visualization of the Puncture Tract

Commentary on “CIRSE Standards of Practice on Percutaneous Transhepatic Cholangiography, Biliary Drainage and Stenting”: Visualization of the Puncture Tract

EUS-guided versus percutaneous transhepatic cholangiography biliary drainage for obstructed distal malignant biliary strictures in patients who have failed endoscopic retrograde cholangiopancreatography: A systematic review and meta-analysis.

EUS-guided biliary drainage (EUS-BD) and percutaneous transhepatic cholangiography biliary drainage (PTC) are the two alternate methods for biliary decompression in cases where ERCP fails. We conducted a systematic review and meta-analysis of studies to compare the efficacy and safety of endoscopic and percutaneous biliary drainage for malignant biliary obstruction in patients with failed ERCP. A total of ten studies were included, fulfilling the inclusion criteria, including four retrospective studies and six randomized controlled trials. We compared the technical and clinical success rates and the acute, delayed, and total adverse events of EUS-BD with PTC. The odds ratios (ORs) and confidence intervals (CIs) were calculated. There was no difference between technical (OR: 0.47 [95% CI: 0.20–1.07]; P = 0.27) and clinical (OR: 2.24 [95% CI: 1.10–4.55]; P = 0.51) success rates between EUS-PD and PTC groups. Procedural adverse events (OR: 0.17 [95% CI: 0.09–0.31]; P = 0.03) and total adverse events (OR: 0.09 [95% CI: 0.02–0.38]; P < 0.01) were significantly different between the two groups; however, delayed adverse events were nonsignificantly different (OR: 0.73 [95% CI: 0.34–1.57]; P = 0.97). This meta-analysis indicates that endoscopic biliary drainage (EUS-BD) is equally effective but safer in terms of acute and total adverse events than percutaneous transhepatic biliary drainage (PTC) for biliary decompression in patients with malignant biliary strictures who have failed an ERCP.

Intrabiliary Metastasis of Colon Cancer Mimicking Cholangiocarcinoma and Chemotherapy-Induced Sclerosing Cholangitis: A Case Report

Intrabiliary metastasis of colon cancer without the involvement of the hepatic parenchyma is very rare and can cause biliary obstruction. We herein present a rare case of colon cancer metastasis that developed after right hemicolectomy and while undergoing chemotherapy. Computed tomography (CT) of the abdomen and percutaneous transhepatic cholangiography and drainage (PTCD) was performed because of obstructive jaundice. CT-guided biopsy showed high-grade atypical glands that were CK7(−), CK20(+), and CDX-2(+); metastatic adenocarcinoma would be considered first rather than cholangiocarcinoma. Clinicians should be aware that intrabiliary metastasis of colon cancer can mimic cholangiocarcinoma and chemotherapy-induced sclerosing cholangitis.

Factors contributing to survival in hepatic dysfunction due to colorectal cancer

Introduction/Objective. Colorectal cancer (CRC) is currently the third most common cancer in incidence in the United States and accounts for about 8.5% of all cancer related deaths. Our study aim was to determine the parameters that contribute to the survival of CRC patients with hepatic dysfunction, attention to the positive effects on survival when the most appropriate clinical approaches. Methods.Patients with CRC, diagnosed with hepatic dysfunction, and who were followed up in our inpatient service in the last two years were included in our study. Survival rates were analyzed starting from after the development of hepatic failure. Results. A total of 57 patients were included in the study, 44 (77.2%) were colon carcinoma, and 13 (22.8%) were rectal carcinoma patients, and 14 (24.56%) were female. Bile duct dilatation (BD) was detected in 19 (33%) of 57 patients with imaging methods. The median OS was calculated as 4 vs. 1.4 months in patients with BD compared to patients without BD (p &lt; 0.001). Survival times were significantly higher in patients with BD compared to those without dilatation, and in patients without renal failure compared to those with renal failure. Conclusion. In cancer patients with hepatic dysfunction, those with additional renal failure had shorter survival times and a worse prognosis. The longer survival of patients with BD was attributed to the optimal timing of the percutaneous transhepatic cholangiography insertion, close clinical and inflammation marker follow-ups, and early prevention of external biliary drainage, therefore preventing a possible septic complication early on.

THE USE OF ANTEGRADE ENDOBILIARY INTERVENTIONS IN BENIGN DISEASES OF THE BILIARY TRACT COMPLICATED BY MECHANICAL JAUNDICE

Introduction. One of the most common manifestations of diseases of the biliary tract are strictures or stenoses. They can have malignant, inflammatory and traumatic etiology, as well as be accompanied by mechanical jaundice syndrome.&#x0D; Aim. To study the results of the use of antegrade endobiliary interventions in benign diseases of the biliary tract complicated by mechanical jaundice.&#x0D; Materials and methods. An analysis of surgical treatment of 34 patients with benign diseases of the biliary tract complicated by mechanical jaundice (MJ) in the SI “V.T. Zatsev IGUS NAMSU». Choledocholithiasis was the cause of MF in 21 (61.8 %) cases, stricture of the LV in 6 (17.6 %) and stricture of the biliodigestive anastomosis (BDA) in 7 (20.6 %) patients. BDA strictures developed after the following operations: biliobiliostomy — 1 (14.3 %), hepaticojejunostomy — 3 (42.9 %), choledochoduodenoanastomosis — 2 (28.5 %) and hepaticoduodenostomy — 1 (14.3 %) %).&#x0D; Research results. External percutaneous transhepatic cholangiodrainage was performed in 7 (46.7 %) patients, external-internal percutaneous transhepatic cholangiodrainage was performed in 6 (40 %), percutaneous transhepatic cholecystostomy was performed in 2 (13.4 %) patients. With slightly dilated intrahepatic ducts (&lt;5 mm) cholangiodrainage was established in 3 (20 %) patients. Of these, in 3 (20.0 %) cases, a separate percutaneous transhepatic cholangiodrainage of the right and left lobular ducts of the liver was performed. Performing percutaneous transhepatic cholangiography and percutaneous transhepatic cholangiodrainage allows to determine the level and nature of biliary block in a minimally invasive way, to perform biliary decompression and prevention of complications after an unsuccessful attempt at endoscopic treatment.&#x0D; Conclusions. By using antegrade endobiliary interventions, we were able to reduce the risk of biliary decompression complications compared with patients who had unsuccessful attempts at endoscopic treatment from 15 (78.9 %) to 1 (6.67 %), and to reduce the number of complications after reconstructive rehabilitation. operations from 10 (52.6 %) to 1 (6.67 %) and the mortality rate from 2 (10.5 %) to 1 (6.67 %).

Improving rehabilitation and quality of life after percutaneous transhepatic cholangiography drainage with a rapid rehabilitation model.

BACKGROUNDPercutaneous transhepatic cholangiography drainage (PTCD) effectively treats biliary obstruction. However, patients must maintain the drainage tube after hospital discharge, which may interfere with daily life and work, potentially causing psychological distress. Postoperative rehabilitation is crucial, and strengthened nursing interventions can shorten recovery time.AIMThe aim was to evaluate an inpatient model to shorten rehabilitation duration and improve quality of life after PTCD.METHODSA total of 118 patients with malignant obstructive jaundice who were admitted to our hospital between May 2018 and January 2021 were included and divided into observational (with therapy) and control (no therapy) groups of 59 each.RESULTSThe observational group had fewer hospitalization days than the control group. The complication, the PTCD fixed-tube prolapse, and tube-related admission rates within 3 mo after PTCD were significantly lower in the observation group than in the control group (P < 0.05). The fatigue, pain, nausea, vomiting, pruritus, emaciation, and fever scores after PTCD decreased in both groups compared with the scores before PTCD (P < 0.05). The quality of life scores after the intervention were higher in the observation than in the control group (P < 0.05).CONCLUSIONThe model promoted rehabilitation after PTCD, reduced post-PTCD complications, and the tube-related admissions in the 3 mo after the procedure, and improved the quality of life.

Current management of choledocholithiasis after bariatric surgery

The increasing prevalence of obesity all over world has led to a growing number of metabolic and bariatric surgeries. Bariatric surgery is more effective for weight loss than medical therapy, with Roux-en-Y gastric bypass (RYGB) being considered the gold standard of care over the past decade. Bariatric surgery and the subsequent weight loss are associated with an increased risk for the development of gallstone formation. Common bile duct stones prevalence around 10% among patients with symptomatic gallbladder stones. Choledocholithiasis can be technically challenging problem to treat in patients post-laparoscopic RYGB (LRYGB) or a biliopancreatic diversion (BPD/DS) due to the altered upper gastrointestinal anatomy. This review describes the different treatment options of common bile duct stones after malabsorptive bariatric surgery, success rate, and adverse effects of each treatment modality including enteroscopy-assisted endoscopic retrograde cholangiopancreatography (EA-ERCP), percutaneous transhepatic cholangiography (PTC), endoscopic ultrasound-directed transgastric retrograde cholangiopancreatography (EDGE), and laparoscopic-assisted ERCP (LAERCP).

Laparoscopic Treatment оf Mirizzi Syndrome

Background. Mirizzi syndrome (MS) is a relatively rare complication of cholelithiasis, which occurs in a wide range from 0.2 to 5% according to different authors. Today, the surgical treatment of MS remains a challenge.Aim of study. To determine the possibilities of laparoscopic interventions in the surgical correction of various types of MS.Material AND methods. The work is based on a prospective analysis of cases of laparoscopic treatment of 19 patients with MS who were treated in the emergency surgery departments of the Republican Scientific Center for Emergency Medical Care in 2017–2019. This is 22.9% of all admitted patients (83) with MS during this period. Type 1 MS was diagnosed in 3 patients (15.7%), type 2 was diagnosed in 16 patients (84.2%).Results. In all cases of type 1 MS, laparoscopic cholecystectomy was performed. A new method for the correction of type 2 MS by forming a sleeve from the gallbladder wall was suggested, which was performed in 10 patients with good results. In the postoperative period, no nonspecific complications were observed in patients undergoing laparoscopic interventions. One patient had residual choledocholithiasis, which was managed by day 5 after the surgery with endoscopic retrograde cholangiopancreatography and endoscopic papillosphincterotomy and the removal of the calculus from the common bile duct. The average duration of stay of patients in a hospital bed was 10.8 days. Fatal outcome was observed in 1 case (5.3%).Conclusion. 1. The inclusion of endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography and magnetic resonance imaging cholangiography in the diagnostic scheme improves the accuracy and quality of recognition of Mirizzi syndrome and allows the indications for the use of video laparoscopy to be evaluated. 2. Indication for laparocopic treatment of type 2 Mirizzi syndrome is the presence of a single calculus in the supraduodenal part of the common bile duct, which makes it possible to reduce the number of conversion to laparotomy. 3. In cases of type 1 Mirizzi syndrome, the operation of choice is laparoscopic cholecystectomy. 4. The operation of choice in patients with type 2 Mirizzi syndrome is laparoscopic subtotal cholecystectomy, fistula plasty with a gallbladder flap on the Kehr’s T-tube drain with the formation of a “cystic duct”-type sleeve.

“Diagnostic-Therapeutic Management in Patients with Extrahepatic Bile Duct Cancer”

Introduction: Biliary tract tumors, or cholangiocarcinomas (CCAs), comprise a heterogeneous group of malignant tumors that can affect any part of the biliary tree, from the interlobular canals of Hering to the primary biliary duct. In the last 20-30 years, the incidence of these tumours has increased especially after the introduction of the new imaging techniques endoscopic retrograde cholangiopancreatography (ERCP, percutaneous transhepatic cholangiography) and the increased interest for this pathology. Objective: To evaluate the diagnostic methods and therapeutical results in patients with extrahepatic bile duct cancer. Material and Method: This cross-sectional study was conducted in the Department of Surgery, Department of Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from Jun-2018 to July-2021. We included 124 consecutive patients with suspected bile duct cancer who underwent endoscopic retrograde cholangiopancreatography (ERCP). Every patient underwent an ultrasound (US) examination before ERCP. ERCP was considered as the “gold standard” for diagnosis. The therapy applied consisted of endoscopic stenting, US guided biliary drainage or surgery. The sensitivity, specificity and accuracy were calculated for every tumour localisation and also globally for all tumours. Results. The sensitivity, specificity and accuracy of US were 85.9%, 76.9% and 84.4% for hilar localization, 59.1%, 50% and 57.1% for the mid common bile duct (CBD) and 33.3%, 42.8% and 36.8% for the distal CBD tumours. The global performances for US in diagnosing extrahepatic chlonagiocarcinoma were 73.5%, 61.5% and 70.9%. In 73 cases (74.5%) an endoscopic stent was placed. In 11 cases (11.2%) we performed an US guided biliary drainage and in 14 cases (14.2%) surgery was recommended. Conclusion: Ultrasonography proved to be a reliable method for the diagnosis of bile duct cancer in spite of its low accuracy for distal localization. The combination of the two investigations (US and ERCP) was very efficient in the management of these patients. Endoscopic stenting for hilar localization is a good therapeutical option.

Institutional Diagnostic Reference Levels and Peak Skin Doses in selected diagnostic and therapeutic interventional radiology procedures.

Institutional (local) Diagnostic Reference Levels for Cerebral Angiography (CA), Percutaneous Transhepatic Cholangiography (PTC), Transarterial Chemoembolization (TACE) and Percutaneous Transhepatic Biliary Drainage (PTBD) are reported in this study. Data for air kerma-area product (PKA), air kerma at the patient entrance reference point (Ka,r), fluoroscopy time (FT) and number of images (NI) as well as estimates of Peak Skin Dose (PSD) were collected for 142 patients. Therapeutic procedure complexity was also evaluated, in an attempt to incorporate it into the DRL analysis. Local PKA DRL values were 70, 34, 189 and 54Gy.cm2 for CA, PTC, TACE and PTBD respectively. The corresponding DRL values for Ka,r were 494, 194, 1186 and 400mGy, for FT they were 9.2, 14.2, 27.5 and 22.9min, for the NI they were 844, 32, 602 and 13 and for PSD they were 254, 256, 1598 and 540mGy respectively. PKA for medium complexity PTBD procedures was 2.5 times higher than for simple procedures. For TACE, the corresponding ratio was 1.6. PSD was estimated to be roughly 50% of recorded Ka,r for procedures in the head/neck region and 10% higher than recorded Ka,r for procedures in the body region. In only 5 cases the 2Gy dose alarm threshold for skin deterministic effects was exceeded. Procedure complexity can differentiate DRLs in Interventional Radiology procedures. PSD could be deduced with reasonable accuracy from values of Ka,r that are reported in every angiography system.

CONTRAST-ENHANCED COMPUTED TOMOGRAPHIC CHOLANGIOGRAPHY IN DIFFERENTIAL DIAGNOSIS OF THE MALIGNANT AND BENIGN CAUSES OF BILIARY OBSTRUCTION

Introduction. Determination of the cause of cholestasis and treatment of patients with obstructive jaundice syndrome remains challenging owing to the steady rise in diseases of the hepatopancreatoduodenal zone and the high frequency of diagnostic errors. In the differential diagnosis of the causes of obstructive jaundice, diagnostic imaging techniques are of the greatest importance. In the world literature, there are few reports on the assessment of the diagnostic potential of multispiral computed tomography under conditions of direct contrasting of the biliary tree using endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, or through pre-installed palliative drainage in the bile ducts. There is no generally accepted algorithm for determining the causes of biliary obstruction. It leads to ineffective use of various diagnostic imaging techniques, complicating the diagnostic process.The purpose of the study was to evaluate the diagnostic efficacy of contrast-enhanced ct cholangiography (ct-cg) in the differential diagnosis of causes of malignant and benign biliary obstruction in cases with obstructive jaundice syndrome.Material and methods. The study included 55 patients with obstructive jaundice, who were treated in a surgical hospital from july 2016 to july 2019.Results. It was found that contrast ct-cg in diagnosing the causes of biliary obstruction of both malignant and benign genesis is more informative than x-ray endoscopic retrograde cholangiopancreatography. The diagnostic efficacy of ct-cg in detecting causes of malignant biliary obstruction was: 93.3% sensitivity, 92.9% specificity, and 93.1% accuracy. The diagnostic efficacy of ct-cg in detecting causes of benign biliary obstruction was: 92.9%, 93.3% and 93.1%, respectively.Conclusion. Based on the high accuracy, contrast-enhanced ct-cg is a promising imaging technique in cases with bile duct obstruction.

Complications of percutaneous transhepatic cholangiography and biliary drainage, a multicenter observational study

ObjectivesOver 2500 percutaneous transhepatic cholangiography and biliary drainage (PTCD) procedures are yearly performed in the Netherlands. Most interventions are performed for treatment of biliary obstruction following unsuccessful endoscopic biliary cannulation. Our aim was to evaluate complication rates and risk factors for complications in PTCD patients after failed ERCP.MethodsWe performed an observational study collecting data from a cohort that was subjected to PTCD during a 5-year period in one academic and four teaching hospitals. Primary objective was the development of infectious (sepsis, cholangitis, abscess, or cholecystitis) and non-infectious complications (bile leakage, severe hemorrhage, etc.) and mortality within 30 days of the procedure. Subsequently, risk factors for complications and mortality were analyzed with a multilevel logistic regression analysis.ResultsA total of 331 patients underwent PTCD of whom 205 (61.9%) developed PTCD-related complications. Of the 224 patients without a pre-existent infection, 91 (40.6%) developed infectious complications, i.e., cholangitis in 26.3%, sepsis in 24.6%, abscess formation in 2.7%, and cholecystitis in 1.3%. Non-infectious complications developed in 114 of 331 patients (34.4%). 30-day mortality was 17.2% (N = 57). Risk factors for infectious complications included internal drainage and drain obstruction, while multiple re-interventions were a risk factor for non-infectious complications.ConclusionBoth infectious and non-infectious complications are frequent after PTCD, most often due to biliary drain obstruction.

Percutaneous Management of Benign Biliary Strictures.

Benign biliary strictures are often due to a variety of etiologies, most of which are iatrogenic. Clinical presentation can vary from asymptomatic disease with elevated liver enzymes to obstructive jaundice and recurrent cholangitis. Diagnostic imaging methods, such as ultrasound, multidetector computed tomography, and magnetic resonance imaging (cholangiopancreatography), are used to identify stricture location, extent, and possible source of biliary obstruction. The management of benign biliary strictures requires a multidisciplinary team approach and include endoscopic, percutaneous, and surgical interventions. Percutaneous biliary interventions provide an alternative diagnostic and therapeutic approach, especially in patients who are not amenable to endoscopic evaluation. This review provides an overview of benign biliary strictures and percutaneous management by interventional radiologists. Diagnostic evaluation with percutaneous transhepatic cholangiography and treatment options, including biliary drainage, balloon dilation, retrievable/biodegradable stents, and other innovative minimally invasive options, are discussed.