Double-catheter method to prevent dislodgement during percutaneous transhepatic cholangioscopy

Area of Science:

• Gastroenterology
• Interventional Radiology
• Endoscopic Procedures

Background:

• Percutaneous transhepatic cholangioscopy (PTCS) requires a stable track for catheter insertion.
• The conventional single-catheter method for track dilation carries a risk of dislodgement.

Purpose of the Study:

• To evaluate the efficacy of a double-catheter technique in establishing a track for PTCS.
• To compare the outcomes of the double-catheter method versus the single-catheter method for PTCS track creation.

Main Methods:

• Prospective analysis of 105 patients undergoing PTCS track dilation to 16F.
• Comparison of single-catheter (n=22) versus double-catheter (n=83) methods.
• Subclassification of the double-catheter method based on outer catheter placement relative to biliary stenosis (Method 2A vs. 2B).

Main Results:

• Catheter dislodgement occurred in 18% of single-catheter cases but none with the double-catheter method (p < 0.0005).
• Method 2A (outer catheter not advanced through stenosis) had 0% morbidity.
• Method 2B (outer catheter advanced through stenosis) had 14% morbidity (p < 0.005).

Conclusions:

• The double-catheter method significantly reduces PTCS catheter dislodgement.
• Optimal outcomes are achieved by avoiding advancement of the outer catheter through biliary stenoses.