Percutaneous Transhepatic Cholangiography

Initially reported in 1937, percutaneous transhepatic cholangiography (PTC) is an invasive procedure to visualize and subsequently access the biliary tract (see Percutaneous Transhepatic Cholangiography). PTC involves inserting a needle through the skin, body wall, and liver parenchyma to inject contrast dye directly into the bile ducts. PTC can become important for clinical decision-making or as a precursor to therapy when endoscopic access to the bile ducts is not possible, or other imaging techniques offer inadequate information. PTC provides higher-resolution images of bile duct obstructions, strictures, and leaks than ultrasound, nuclear imaging, computed tomography, and magnetic resonance imaging, including magnetic resonance cholangiopancreatography. After performing PTC, percutaneous interventions of the bile ducts can be attempted, including bile duct stone removal, biopsy, stenting, and drainage. Percutaneous transhepatic biliary drainage (PTBD) was introduced in 1981. For patients with contraindications to bile duct access via endoscopic guidance, such as endoscopic retrograde cholangiopancreatography or choledochoduodenoscopy, PTC and PTBD remain less invasive than surgical access. This activity describes therapies performed in conjunction with PTC to illustrate when PTC is indicated or contraindicated. However, a discussion of these therapies' technical performance and therapeutic outcomes is beyond this topic's scope.