Against the Odds: A Novel Technique to Perform Cholangiography from a Percutaneous Approach through the Cystic Duct

Percutaneous cholangiography is typically performed via a transhepatic approach and is reserved for patients with contraindications to traditional cholangiogram imaging modalities. For those with suspected cholelithiasis or choledocholithiasis who cannot undergo magnetic resonance imaging for diagnosis, percutaneous cholecystostomy with cholangiogram is a viable option. Endoscopic retrograde cholangiopancreatography may also be precluded due to anatomic or obstructive limitations, in which case, percutaneous transhepatic cholangiography (PTC) may be indicated for diagnosis. PTC may be difficult in a patient with minimal biliary tree dilatation, or tortuous cystic duct anatomy. In cases such as these, a steerable microcatheter (SMC) may be utilized to enable or expedite PTC. The technique to traverse and catheterize the cystic duct and opacify the gallbladder, bile ducts, and duodenum utilizing an SMC is described. This report outlines a non-vascular application of the SMC resulting in a successful cholangiogram, with reduced operative time and thus reduced radiation exposure to the patient.