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Transhepatic Biliary Interventions
Amanda L. Scott, DO; Kenneth H. Cho, MD, MBA; Brian Holly, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Outcomes

          TERMINOLOGY

          • Definitions

            • Percutaneous transhepatic cholangiography (PTC): Minimally invasive radiologic technique used to visualize biliary tract anatomy
              • Needle introduced through skin into liver to access biliary tract and inject contrast medium
              • Usually combined with percutaneous intervention
            • Percutaneous biliary drainage (PBD): Placement of drainage catheter into biliary tract
              • External drainage: Percutaneous biliary drain with catheter tip in biliary system
              • Internal/external drainage: Percutaneous biliary drain with catheter tip in bowel
              • Biliary metal stent: Covered or uncovered self-expanding metal stent (SEMS) placed in biliary tree for drainage

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Procedure Steps

                      • Findings and Reporting

                        • Alternative Procedures/Therapies

                          POST PROCEDURE

                          • Things to Do

                            • Things to Avoid

                              OUTCOMES

                              • Complications

                                • Expected Outcomes

                                  Selected References

                                  1. Rudnick MR et al: Contrast-associated and contrast-induced acute kidney injury: clinical features, diagnosis, and management. Updated July 2020. Accessed April 12, 2022. https://www.uptodate.com/contents/contrast-associated-and-contrast-induced-acute-kidney-injury-clinical-features-diagnosis-and-management
                                  2. Devane AM et al: Society of Interventional Radiology quality improvement standards for percutaneous cholecystostomy and percutaneous transhepatic biliary interventions. J Vasc Interv Radiol. 31(11):1849-56, 2020
                                  3. Chehab MA et al: Adult and pediatric antibiotic prophylaxis during vascular and IR procedures: a Society of Interventional Radiology practice parameter update endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology. J Vasc Interv Radiol. 29(11):1483-501.e2, 2018
                                  4. Kapoor BS et al: Management of biliary strictures: state-of-the-art review. Radiology. 289(3):590-603, 2018
                                  5. Tringali A et al: Covered vs. uncovered self-expandable metal stents for malignant distal biliary strictures: a systematic review and meta-analysis. Endoscopy. 50(6):631-41, 2018
                                  6. Venkatanarasimha N et al: Diagnosis and management of complications from percutaneous biliary tract interventions. Radiographics. 37(2):665-80, 2017
                                  7. Ahmed O et al: Biliary interventions: tools and techniques of the trade, access, cholangiography, biopsy, cholangioscopy, cholangioplasty, stenting, stone extraction, and brachytherapy. Semin Intervent Radiol. 33(4):283-90, 2016
                                  8. Inamdar S et al: Comparison of adverse events for endoscopic vs percutaneous biliary drainage in the treatment of malignant biliary tract obstruction in an inpatient national cohort. JAMA Oncol. 2(1):112-7, 2016
                                  9. Thomas S et al: Noninvasive imaging of the biliary system relevant to percutaneous interventions. Semin Intervent Radiol. 33(4):277-82, 2016
                                  10. Wible BC et al: Ethylene-vinyl alcohol copolymer endobiliary obliteration of hepatic segments in a patient with isolated bile leaks. J Vasc Interv Radiol. 25(11):1821-5, 2014
                                  11. Kim JH et al: Temporary placement of retrievable fully covered metallic stents versus percutaneous balloon dilation in the treatment of benign biliary strictures. J Vasc Interv Radiol. 22(6):893-9, 2011
                                  12. Thornton RH et al: Catheter-free survival after primary percutaneous stenting of malignant bile duct obstruction. AJR Am J Roentgenol. 197(3):W514-8, 2011
                                  13. Kullman E et al: Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study. Gastrointest Endosc. 72(5):915-23, 2010
                                  14. Moon E et al: Prophylactic antibiotic guidelines in modern interventional radiology practice. Semin Intervent Radiol. 27(4):327-37, 2010
                                  15. Saad WE et al: Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy. J Vasc Interv Radiol. 21(6):789-95, 2010
                                  16. Telford JJ et al: A randomized trial comparing uncovered and partially covered self-expandable metal stents in the palliation of distal malignant biliary obstruction. Gastrointest Endosc. 72(5):907-14, 2010
                                  17. Pomerantz BJ: Biliary tract interventions. Tech Vasc Interv Radiol. 12(2):162-70, 2009
                                  18. Brown KT et al: Management of malignant biliary obstruction. Tech Vasc Interv Radiol. 11(1):43-50, 2008
                                  19. Covey AM et al: Percutaneous transhepatic biliary drainage. Tech Vasc Interv Radiol. 11(1):14-20, 2008
                                  20. Fidelman N et al: Hepatic arterial injuries after percutaneous biliary interventions in the era of laparoscopic surgery and liver transplantation: experience with 930 patients. Radiology. 247(3):880-6, 2008
                                  21. Saad WE et al: Management of bleeding after percutaneous transhepatic cholangiography or transhepatic biliary drain placement. Tech Vasc Interv Radiol. 11(1):60-71, 2008
                                  22. Saad WE: Percutaneous management of postoperative anastomotic biliary strictures. Tech Vasc Interv Radiol. 11(2):143-53, 2008
                                  23. Saad WE: Transhepatic techniques for accessing the biliary tract. Tech Vasc Interv Radiol. 11(1):21-42, 2008
                                  24. Calvo MM et al: The rendezvous technique for the treatment of choledocholithiasis. Gastrointest Endosc. 54(4):511-3, 2001
                                  25. Gazelle GS et al: Cholangiographic segmental anatomy of the liver. Radiographics. 14(5):1005-13, 1994
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Preprocedure

                                      • Procedure

                                        • Outcomes

                                          TERMINOLOGY

                                          • Definitions

                                            • Percutaneous transhepatic cholangiography (PTC): Minimally invasive radiologic technique used to visualize biliary tract anatomy
                                              • Needle introduced through skin into liver to access biliary tract and inject contrast medium
                                              • Usually combined with percutaneous intervention
                                            • Percutaneous biliary drainage (PBD): Placement of drainage catheter into biliary tract
                                              • External drainage: Percutaneous biliary drain with catheter tip in biliary system
                                              • Internal/external drainage: Percutaneous biliary drain with catheter tip in bowel
                                              • Biliary metal stent: Covered or uncovered self-expanding metal stent (SEMS) placed in biliary tree for drainage

                                          PREPROCEDURE

                                          • Indications

                                            • Contraindications

                                              • Preprocedure Imaging

                                                • Getting Started

                                                  PROCEDURE

                                                  • Patient Position/Location

                                                    • Procedure Steps

                                                      • Findings and Reporting

                                                        • Alternative Procedures/Therapies

                                                          POST PROCEDURE

                                                          • Things to Do

                                                            • Things to Avoid

                                                              OUTCOMES

                                                              • Complications

                                                                • Expected Outcomes

                                                                  Selected References

                                                                  1. Rudnick MR et al: Contrast-associated and contrast-induced acute kidney injury: clinical features, diagnosis, and management. Updated July 2020. Accessed April 12, 2022. https://www.uptodate.com/contents/contrast-associated-and-contrast-induced-acute-kidney-injury-clinical-features-diagnosis-and-management
                                                                  2. Devane AM et al: Society of Interventional Radiology quality improvement standards for percutaneous cholecystostomy and percutaneous transhepatic biliary interventions. J Vasc Interv Radiol. 31(11):1849-56, 2020
                                                                  3. Chehab MA et al: Adult and pediatric antibiotic prophylaxis during vascular and IR procedures: a Society of Interventional Radiology practice parameter update endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology. J Vasc Interv Radiol. 29(11):1483-501.e2, 2018
                                                                  4. Kapoor BS et al: Management of biliary strictures: state-of-the-art review. Radiology. 289(3):590-603, 2018
                                                                  5. Tringali A et al: Covered vs. uncovered self-expandable metal stents for malignant distal biliary strictures: a systematic review and meta-analysis. Endoscopy. 50(6):631-41, 2018
                                                                  6. Venkatanarasimha N et al: Diagnosis and management of complications from percutaneous biliary tract interventions. Radiographics. 37(2):665-80, 2017
                                                                  7. Ahmed O et al: Biliary interventions: tools and techniques of the trade, access, cholangiography, biopsy, cholangioscopy, cholangioplasty, stenting, stone extraction, and brachytherapy. Semin Intervent Radiol. 33(4):283-90, 2016
                                                                  8. Inamdar S et al: Comparison of adverse events for endoscopic vs percutaneous biliary drainage in the treatment of malignant biliary tract obstruction in an inpatient national cohort. JAMA Oncol. 2(1):112-7, 2016
                                                                  9. Thomas S et al: Noninvasive imaging of the biliary system relevant to percutaneous interventions. Semin Intervent Radiol. 33(4):277-82, 2016
                                                                  10. Wible BC et al: Ethylene-vinyl alcohol copolymer endobiliary obliteration of hepatic segments in a patient with isolated bile leaks. J Vasc Interv Radiol. 25(11):1821-5, 2014
                                                                  11. Kim JH et al: Temporary placement of retrievable fully covered metallic stents versus percutaneous balloon dilation in the treatment of benign biliary strictures. J Vasc Interv Radiol. 22(6):893-9, 2011
                                                                  12. Thornton RH et al: Catheter-free survival after primary percutaneous stenting of malignant bile duct obstruction. AJR Am J Roentgenol. 197(3):W514-8, 2011
                                                                  13. Kullman E et al: Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study. Gastrointest Endosc. 72(5):915-23, 2010
                                                                  14. Moon E et al: Prophylactic antibiotic guidelines in modern interventional radiology practice. Semin Intervent Radiol. 27(4):327-37, 2010
                                                                  15. Saad WE et al: Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy. J Vasc Interv Radiol. 21(6):789-95, 2010
                                                                  16. Telford JJ et al: A randomized trial comparing uncovered and partially covered self-expandable metal stents in the palliation of distal malignant biliary obstruction. Gastrointest Endosc. 72(5):907-14, 2010
                                                                  17. Pomerantz BJ: Biliary tract interventions. Tech Vasc Interv Radiol. 12(2):162-70, 2009
                                                                  18. Brown KT et al: Management of malignant biliary obstruction. Tech Vasc Interv Radiol. 11(1):43-50, 2008
                                                                  19. Covey AM et al: Percutaneous transhepatic biliary drainage. Tech Vasc Interv Radiol. 11(1):14-20, 2008
                                                                  20. Fidelman N et al: Hepatic arterial injuries after percutaneous biliary interventions in the era of laparoscopic surgery and liver transplantation: experience with 930 patients. Radiology. 247(3):880-6, 2008
                                                                  21. Saad WE et al: Management of bleeding after percutaneous transhepatic cholangiography or transhepatic biliary drain placement. Tech Vasc Interv Radiol. 11(1):60-71, 2008
                                                                  22. Saad WE: Percutaneous management of postoperative anastomotic biliary strictures. Tech Vasc Interv Radiol. 11(2):143-53, 2008
                                                                  23. Saad WE: Transhepatic techniques for accessing the biliary tract. Tech Vasc Interv Radiol. 11(1):21-42, 2008
                                                                  24. Calvo MM et al: The rendezvous technique for the treatment of choledocholithiasis. Gastrointest Endosc. 54(4):511-3, 2001
                                                                  25. Gazelle GS et al: Cholangiographic segmental anatomy of the liver. Radiographics. 14(5):1005-13, 1994