Percutaneous transhepatic cholangiography (PTHC)
Percutaneous transhepatic cholangiography (PTHC) is a diagnostic procedure designed to visualize the liver and bile ducts. It is commonly utilized in surgical settings to explore the biliary tract for nonpalpable gallstones or tumors and can also be performed postoperatively in a radiology suite to assess the patency of biliary drainage systems and identify any residual stones or obstructions. PTHC plays a crucial role in diagnosing various cancers, including bile duct, pancreatic, and gallbladder cancers.
The procedure typically involves the injection of radiopaque material into the biliary system, followed by X-ray imaging to capture detailed views of the bile ducts. Preparation for PTHC often requires standard pre-surgical protocols, and advancements in technology have improved its safety and effectiveness, including the incorporation of ultrasound guidance and simulation training for physicians. Patients generally receive results within a few days, and they are encouraged to discuss any concerns with their healthcare providers to ensure a clear understanding of the procedure and its implications. PTHC continues to evolve, increasing its utility in the management of biliary tract conditions.
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Percutaneous transhepatic cholangiography (PTHC)
ALSO KNOWN AS: Operative cholangiography, T-tube cholangiography, cystic duct cholangiography
DEFINITION: Percutaneous transhepatic cholangiography (PTHC) is a diagnostic test used to visualize the liver or bile ducts. Although this procedure is frequently performed in the operating room at the time of exploration of the biliary tract for nonpalpable gallstones or tumors, it can also be performed postoperatively in the radiology suite to assess catheter patency and drainage and to evaluate for the presence of residual stones or residual narrowing or obstruction of the biliary tract.
Cancers diagnosed:Bile duct carcinoma, pancreatic cancer, gallbladder cancer
Why performed: The main application of PTHC is to avoid common bile duct surgical exploration, identify calculi that have escaped palpation, and evaluate for the presence of biliary tract or pancreatic tumors. The intrapancreatic segment of the common bile duct is often altered by pancreatic cancer, and PTHC can be used for its evaluation. Postoperative cholangiography is usually performed in the X-ray suite prior to removal of the T tube placed at the time of surgery to demonstrate the patency of the common duct, the absence of retained stones, and the free passage of bile into the duodenum.
Patient preparation: This procedure is frequently performed in the operating room at the time of exploration of the biliary tract for nonpalpable stones or tumors. Therefore, patient preparation is determined by the surgeon prior to the procedure and commonly involves the usual preadmission testing performed before any surgical procedure, as well as instructions such as nothing by mouth after midnight the night before the procedure.
Steps of the procedure: Radiopaque material is injected by the surgeon into the cystic duct while the patient is still in the operating room. Alternatively, after surgery, radiopaque material may be injected into the T tube by a radiologist in the radiology suite. This tube was placed in the common duct intraoperatively using a sterile technique under fluoroscopic guidance. In both situations, X-ray images are then taken. In some cases, a trained interventional radiologist, under fluoroscopic control and using sterile technique, can insert a fine needle directly into the biliary tree and outline the intrahepatic ducts, the common ducts, and the common bile duct using a contrast medium.
After the procedure: If a T tube was placed in the common duct intraoperatively, then the procedure is performed as an inpatient procedure (during the patient’s hospital stay). Patients should consult their healthcare providers if they have any questions or concerns regarding the use of a T-tube cholangiogram or PTHC.
In the twenty-first century, advances have been made in PTHC's safety, effectiveness, and accuracy. Percutaneous Transhepatic Endoscopic Holmium Laser Lithotripsy is a new technique for performing PTHC, which has increased the procedure's effectiveness in treating bile duct stones. Combining PTHC with ultrasound techniques to guide the needles and catheters has increased the accuracy and safety of PTHC. Further, thanks to simulation technology, doctors can more effectively train using PTHC in real-world settings.
Risks: Patients will consult with their healthcare providers regarding the need for the study, its risks, how it will be done, and what the results indicate.
Results: The radiologist reads the X-ray images taken during the procedure within a couple of days. The patient will need to contact the doctor or health care provider for the radiology report and for follow-up therapy. Results depend on the reason for the study, such as exploring the biliary tract for nonpalpable stones or tumors.
Bibliography
Arellano, Ronald S. Non-Vascular Interventional Radiology of the Abdomen. New York: Springer, 2011.
“Bile Duct Cancer Treatment - Cholangiocarcinoma Treatment.” American Cancer Society, www.cancer.org/cancer/types/bile-duct-cancer/treating.html. Accessed 24 June 2024.
“Bile Duct Cancer Treatment.” National Cancer Institute, 24 May 2024, www.cancer.gov/types/liver/bile-duct-cancer/treatment. Accessed 24 June 2024.
Healy, Kelly, et al. "Percutaneous Endoscopic Holmium Laser Lithotripsy for Management of Complicated Biliary Calculi." JSLS: Journal of the Society of Laparoendoscopic Surgeons, vol. 13, no. 2, 2009, pp. 184-189, www.ncbi.nlm.nih.gov/pmc/articles/PMC3015947. Accessed 24 June 2024.
LeWine, Howard E. “Percutaneous Transhepatic Cholangiography (PTCA).” Harvard Health, 13 Sept. 2023, www.health.harvard.edu/a‗to‗z/percutaneous-transhepatic-cholangiography-ptca-a-to-z. Accessed 24 June 2024.
“Percutaneous Transhepatic Cholangiogram.” MedlinePlus, 7 Jan. 2023, medlineplus.gov/ency/article/003820.htm. Accessed 24 June 2024.
Thornton, Raymond H., and Anne M. Covey. "Management of Malignant Biliary Tract Obstruction." Image-Guided Interventions: Expert Radiology Series. Edited by Matthew A. Mauro, et al. Philadelphia: Elsevier, 2014.