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Review
. 2021 Aug;38(3):340-347.
doi: 10.1055/s-0041-1731372. Epub 2021 Aug 10.

Percutaneous Biliary Endoscopy

Adam Khayat  1 , Mamdouh Khayat  2 , Michael Cline  2 , Ahsun Riaz  3
Affiliations
Review

Percutaneous Biliary Endoscopy

Adam Khayat et al. Semin Intervent Radiol. 2021 Aug.

Abstract

Biliary endoscopy is underutilized by interventional radiologists and has the potential to become an effective adjunctive tool to help both diagnose and treat a variety of biliary pathology. This is particularly true in cases where endoscopic retrograde cholangiopancreatography fails or is not feasible due to surgically altered anatomy. Both preoperative clinical and technical procedural factors must be taken into consideration prior to intervention. In this article, clinical evaluation, perioperative management, and procedural techniques for percutaneous biliary endoscopy are reviewed.

Keywords: benign biliary strictures; biliary stones; interventional radiology; malignant biliary strictures; percutaneous endoscopy.

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Figures

Fig. 1
Fig. 1
Choledochoscopy in a 68-year-old female with remote history of Roux-en-Y gastric bypass presents with abdominal pain and elevated bilirubin. ( a ) Coronal MIP T2-weighted MRI demonstrates a large stone within the proximal common bile duct with associated internal and external biliary dilatation. ( b ) Cholangiography after placement of an internal/external biliary drain again demonstrates the choledocolith, as well as moderate biliary dilatation. ( c ) Spot radiograph taken during choledocoscopy demonstrates our SpyGlass endoscope directed toward the common bile duct calculus. We placed a safety wire into the bowel during the choledocoscopy to retain access during lithotripsy and stone extraction. ( d ) Cholangiography 2 weeks post choledocoscopy demonstrates a patent common bile duct with resolution of choledocolithasis.
Fig. 2
Fig. 2
Normal appearing biliary mucosa (small arrow). Wire (big arrow) in the bile duct.
Fig. 3
Fig. 3
A 53-year-old man with a focal left hepatic duct stricture. ( a ) Percutaneous transhepatic access was obtained demonstrating a significant focal stricture. ( b ) Cholangioscopy demonstrated abnormal mucosa with lobulation along the biliary epithelium. ( c ) Cholangioscopic biopsy was obtained using a forceps (arrow).
Fig. 4
Fig. 4
Modified Hutson loop access in a 50-year-old female with a deceased donor liver transplant. ( a ) Endoscope in loop going toward liver guided into the bile duct. The sheath is in the Roux limb (black arrow). ( b ) Debris/stone (white arrow) at the hepaticojejunostomy. ( c ) Cholangiography via a balloon occlusion catheter (white arrow) demonstrating multifocal stricturing consistent with ischemic cholangiopathy. ( d ) Wires (white arrow) advanced into the right and left ducts. ( e ) Plastic stents (white arrow) placed via the Hutson loop into the ducts.
Fig. 5
Fig. 5
A 10-mm goose neck snare around the Cotton-Leung stent (arrow) through the SpyGlass Discover (arrow head). This access is through a modified Hutson loop to remove stents.
See this image and copyright information in PMC

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