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

To report on initial experiences with cholangioscopies via an antegrade transhepatic approach by prior percutaneous insertion of a biliary drainage (PTBD) and tract dilation, describing indications, procedural characteristics, complication rates and peri-interventional laboratory changes.

This retrospective, single-arm study reviewed patients undergoing cholangioscopy via a PTBD access route in a tertiary hepatobiliary center from September 2020 to June 2023. Data on demographics and prior surgeries as well as clinical indications, pathology, lab values and medical reports were collected for PTBD insertion, drainage upsizing and cholangioscopy procedures. Complications were classified using the CIRSE classification (grade ≥ 3a defined as major). Follow-up time was defined as the interval between cholangioscopy and the last clinical contact.

Thirteen patients (61.5 % female, mean age 58.3 years) underwent 41 interventions, including 13 PTBD insertions, 15 upsizings, and 13 cholangioscopies. The most common indication was cholestasis for PTBD placement and suspected biliary malignancy for cholangioscopy. Technical success was achieved in all procedures. PTBD insertion was associated with decreased bilirubin levels and an increase in CRP, whereas after cholangioscopy CRP remained stable. Overall complication rates were 2.4 % (n=1, relevant cholangitis) for major complications and 17.1 % (n=7, clinically silent infections) for minor complications. Mean follow-up time was 537.5 ± 400.6 days.

Percutaneous antegrade cholangioscopy using PTBD as an access route appears to be a viable and safe alternative in patients in whom the usual endoscopic retrograde approach failed or is anatomically not accessible. Larger, preferably multicenter studies are required to validate these preliminary single-center findings.