Percutaneous transhepatic cholangioscopy: does its role still exist?

Abstract

Percutaneous transhepatic cholangioscopy (PTCS) is the most widely used modality for diagnosis and treatment of biliary disease. Although many other novel technologies have been developed based on recent advances in endoscopy, PTCS has its own role. In diagnostics, PTCS is used for evaluation of indeterminate biliary strictures, bile duct tumors, and postoperative biliary strictures that cannot be reached by a peroral approach. In therapeutics, the removal of bile duct stones, dilatation of bile duct strictures including postoperative anastomosis site strictures, and local tumor therapy are indications of PTCS. Especially in a therapeutic role, PTCS has the advantage of maneuverability due to a shorter endoscopic length compared to other cholangioscopic modalities. Hence, PTCS has its own indispensable diagnostic and therapeutic roles.

Keywords: Diagnostic role; Percutaneous transhepatic cholangioscopy; Therapeutic role.

Fig. 1

Tumor vessel-abnormally proliferating and tortuous vascular structure on the bile duct mucosa. (A, B) Two cases of indeterminate far distal bile duct lesions that could not be diagnosed with conventional endoscopic retrograde cholangiopancreatography.

Fig. 2

Comparison of conventional white light imaging and narrow band imaging in the case of recurred gallbladder cancer after cholecystectomy. (A) The white light imaging shows tumor vessels and a polypoid mucosal lesion. (B) The narrow band imaging shows papillary structures of mucosal surface (white arrow) and microvasculatures (black arrow) more definitely than white light imaging.

Fig. 3

Postoperative hepaticojejunostomy site stricture dilatation with balloon dilatation and indwelling catheter placement via percutaneous transhepatic cholangioscopy (PTCS). (A) Balloon dilatation was performed on hepaticojejunostomy site stricture. White arrow indicates a waist of balloon at stricture site. (B) After balloon dilatation, 18 Fr PTCS catheter was placed through stricture site. (C) Cholangioscopic view of tight stricture at hepaticojejunostomy site. (D) Cholangioscopic view after 2 months of stricture dilatation showing widened lumen and erythematous mucosal change.

Fig. 4

(A-C) Argon plasma coagulation ablation to intraductal papillary adenoma.