Percutaneous Transhepatic Cholangiography

Radiologists perform percutaneous transhepatic cholangiography to visualize the intrahepatic and extrahepatic bile ducts. It is now done mostly as a prelude to some sort of interventional procedure to relieve obstructions in the bile ducts such as tumours, calculi (stones) or strictures (fibrotic narrowings). This procedure may be done as a permanent palliative procedure or as a bridge to definitive surgery.

The procedure is usually performed under general anaesthesia, but in some circumstances, it might be done under conscious sedation and local anaesthesia. The radiologist first punctures the skin and abdominal wall between the lower ribs with a small needle and then advances the needle into the underlying liver to enter one of the larger intrahepatic bile ducts. Once access to the bile duct has been gained, a guidewire is advanced through the needle. This guidewire moves into the bile duct, down to the duodenum. If it's possible, catheters are passed over the guidewire, after the tract has been dilated and contrast material is injected into the bile ducts under fluoroscopic control before taking fixed X-ray images to display the anatomy of the bile ducts and any obstructing lesions.

With the guidewire in place the catheter can be exchanged for balloon catheters for dilating, biopsy catheters for taking biopsies etc. and drains or self-expanding metallic stents (SEMS) can be deployed across or above an obstruction to relieve jaundice and remove infections.

After the procedure, the patient needs to be monitored for bleeding, bile leaks and sepsis. Drains that exit through the skin may be left in place for a period.