Antegrade cholangioscopy via a percutaneous transhepatic approach-initial single-center experience

Area of Science:

• Hepatobiliary surgery
• Gastroenterology
• Interventional Radiology

Background:

• Cholangioscopy is crucial for diagnosing and treating biliary tract diseases.
• The antegrade transhepatic approach offers an alternative when endoscopic retrograde cholangiopancreatography (ERCP) is not feasible.
• Percutaneous transhepatic biliary drainage (PTBD) can serve as an access route for antegrade cholangioscopy.

Purpose of the Study:

• To evaluate the initial experience with antegrade transhepatic cholangioscopy using a PTBD access route.
• To describe the indications, procedural details, and outcomes of this approach.
• To assess complication rates and peri-interventional laboratory changes.

Main Methods:

• Retrospective review of 13 patients undergoing cholangioscopy via PTBD access from September 2020 to June 2023.
• Data collected included demographics, prior surgeries, indications, pathology, laboratory values, and procedural reports.
• Complications were classified using the CIRSE system; major complications were defined as grade ≥ 3a.

Main Results:

• Forty-one interventions were performed, including PTBD insertions, drainage upsizing, and cholangioscopies.
• Common indications were cholestasis for PTBD and suspected biliary malignancy for cholangioscopy.
• Technical success was 100%; major complication rate was 2.4% (1/41), and minor complication rate was 17.1% (7/41).

Conclusions:

• Antegrade transhepatic cholangioscopy via PTBD is a viable and safe alternative for patients with inaccessible biliary anatomy or failed ERCP.
• This approach facilitates diagnosis and intervention in complex biliary cases.
• Further multicenter studies are needed to confirm these preliminary findings.