Transhepatic Cholangiography and Biliary Drainage: Basic Concepts and Technique

Abstract

Percutaneous transhepatic biliary procedures are essential for managing a variety of hepatobiliary conditions, particularly when endoscopic retrograde cholangiopancreatography is not feasible or has failed, or when patients are unstable. This review article provides a comprehensive overview of the indications, contraindications, and procedural steps for biliary puncture, focusing on techniques such as percutaneous transhepatic biliary drainage (PTBD) and percutaneous cholecystostomy. We also address strategies for accessing minimally dilated biliary systems and performing bedside PTBD. The article highlights the increasing demand for these interventions due to rising incidences of biliary diseases such as gallbladder cancer and cholangiocarcinoma, as well as complications arising from previous surgeries. Furthermore, we discuss common and life-threatening complications associated with these procedures, including biliary leaks, hemorrhage, and sepsis, and provide guidance on effective management strategies. Understanding these procedures and their potential complications is crucial for optimizing patient care and outcomes in complex biliary conditions.

Keywords

PTBD - cholecystostomy - cholangiogram

Ethical Approval

This is a review article. No ethical approval is required from our institutional ethics committee.

Publikationsverlauf

Eingereicht: 07. Juni 2024

Angenommen: 11. September 2024

Artikel online veröffentlicht:
16. Oktober 2024

• References

• 1 Perez-Johnston R, Deipolyi AR, Covey AM. Percutaneous biliary interventions. Gastroenterol Clin North Am 2018; 47 (03) 621-641
• 2 Ahmed O, Mathevosian S, Arslan B. Biliary interventions: tools and techniques of the trade, access, cholangiography, biopsy, cholangioscopy, cholangioplasty, stenting, stone extraction, and brachytherapy. Semin Intervent Radiol 2016; 33 (04) 283-290
• 3 Yadav A, Condati N, Mukund A. Percutaneous transhepatic biliary interventions. J Clin Interventional Radiol 2018; 2 (01) 27-37
• 4 Patel IJ, Rahim S, Davidson JC. et al. Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions - Part II: Recommendations: endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 2019; 30 (08) 1168-1184.e1
• 5 Das A. Percutaneous biliary intervention: tips and tricks. Trop Gastroenterol 2017; 38 (02)
• 6 Moole H, Bechtold M, Puli SR. Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review. World J Surg Oncol 2016; 14 (01) 182
• 7 Modha K. Clinical approach to patients with obstructive jaundice. Tech Vasc Interv Radiol 2015; 18 (04) 197-200
• 8 Mayumi T, Okamoto K, Takada T. et al. Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2018; 25 (01) 96-100
• 9 Afdhal NH, McHutchison JG. Liver function tests and interpretation. Gastroenterology Hepatology Clinics North Am 2003; 32 (01) 209-222
• 10 Mortelé KJ, Rocha TC, Streeter JL, Taylor AJ. Multimodality imaging of pancreatic and biliary congenital anomalies. Radiographics 2006; 26 (03) 715-731
• 11 Castaing D. Surgical anatomy of the biliary tract. HPB (Oxford) 2008; 10 (02) 72-76
• 12 Thabit AK. Antibiotics in the biliary tract: a review of the pharmacokinetics and clinical outcomes of antibiotics penetrating the bile and gallbladder wall. Pharmacotherapy 2020; 40 (07) 672-691
• 13 Moon E, Tam MD, Kikano RN, Karuppasamy K. Prophylactic antibiotic guidelines in modern interventional radiology practice. Semin Intervent Radiol 2010; 27 (04) 327-337
• 14 Tuite C, Rosenberg EJ. Sedation and analgesia in interventional radiology. Semin Intervent Radiol 2005; 22 (02) 114-120
• 15 Hatzidakis AA, Charonitakis E, Athanasiou A. et al. Sedations and analgesia in patients undergoing percutaneous transhepatic biliary drainage. Clin Radiol 2003; 58 (02) 121-127
• 16 Steib A, Hausberger D, Robillart A, Roche A, Franckhauser D, Dupeyron JP. Anesthésie pour imagerie interventionnelle. [Anaesthetic considerations for interventional radiology] Ann Fr Anesth Réanim 2006; 25 (06) 615-625
• 17 Basics of hepatobiliary interventions. Springer eBooks. 2021 Accessed September 26, 2024 at: https://doi.org/10.1007/978-981-15-6856-5
• 18 Behera RK, Srivastava DN, Kumar P. et al. Right-sided versus left-sided percutaneous transhepatic biliary drainage in the management of malignant biliary obstruction: a randomized controlled study. Abdom Radiol (NY) 2021; 46 (02) 768-775
• 19 Funaki B. Percutaneous biliary drainage. Semin Intervent Radiol 2007; 24 (02) 268-271
• 20 Cope C. Usefulness of a percutaneous transhepatic coaxial micropuncture needle technique in patients with nondilated peripheral intrahepatic ducts. AJR Am J Roentgenol 2003; 181 (04) 1017-1020
• 21 Singh J, Tripathy TP, Patel R, Chandel K. Is ultrasound-guided bedside percutaneous transhepatic biliary drainage safe and feasible in critically ill patients with severe cholangitis? A preliminary single-center experience. Indian J Crit Care Med 2023; 27 (01) 16-21
• 22 Gupta P, Maralakunte M, Kalra N. et al. Feasibility and safety of bedside percutaneous biliary drainage in patients with severe cholangitis. Abdom Radiol (NY) 2021; 46 (05) 2156-2160
• 23 Saad WE, Wallace MJ, Wojak JC, Kundu S, Cardella JF. Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy. J Vasc Interv Radiol 2010; 21 (06) 789-795
• 24 Winick AB, Waybill PN, Venbrux AC. Complications of percutaneous transhepatic biliary interventions. Tech Vasc Interv Radiol 2001; 4 (03) 200-206
• 25 Hafezi-Nejad N, Liddell RP. Percutaneous biliary interventions: clinical indications, comparative effectiveness, technical considerations, complications, and outcomes. Gastrointest Endosc Clin N Am 2022; 32 (03) 493-505
• 26 Saad WE, Davies MG, Darcy MD. Management of bleeding after percutaneous transhepatic cholangiography or transhepatic biliary drain placement. Tech Vasc Interv Radiol 2008; 11 (01) 60-71
• 27 Clouse ME, Evans D, Costello P, Alday M, Edwards SA, McDermott Jr WV. Percutaneous transhepatic biliary drainage. Complications due to multiple duct obstructions. Ann Surg 1983; 198 (01) 25-29
• 28 Ahmed M. Acute cholangitis - an update. World J Gastrointest Pathophysiol 2018; 9 (01) 1-7
• 29 Gulaya K, Desai SS, Sato K. Percutaneous cholecystostomy: evidence-based current clinical practice. Semin Intervent Radiol 2016; 33 (04) 291-296
• 30 Akhan O, Akinci D, Ozmen MN. Percutaneous cholecystostomy. Eur J Radiol 2002; 43 (03) 229-236
• 31 Little MW, Briggs JH, Tapping CR. et al. Percutaneous cholecystostomy: the radiologist's role in treating acute cholecystitis. Clin Radiol 2013; 68 (07) 654-660
• 32 Loberant N, Notes Y, Eitan A, Yakir O, Bickel A. Comparison of early outcome from transperitoneal versus transhepatic percutaneous cholecystostomy. Hepatogastroenterology 2010; 57 (97) 12-17
• 33 Ginat D, Saad WE. Cholecystostomy and transcholecystic biliary access. Tech Vasc Interv Radiol 2008; 11 (01) 2-13
• 34 Hatzidakis A, Venetucci P, Krokidis M, Iaccarino V. Percutaneous biliary interventions through the gallbladder and the cystic duct: what radiologists need to know. Clin Radiol 2014; 69 (12) 1304-1311
• 35 Viste A, Jensen D, Angelsen JH, Hoem D. Percutaneous cholecystostomy in acute cholecystitis; a retrospective analysis of a large series of 104 patients. BMC Surg 2015; 15: 17
• 36 van Sonnenberg E, D'Agostino HB, Goodacre BW, Sanchez RB, Casola G. Percutaneous gallbladder puncture and cholecystostomy: results, complications, and caveats for safety. Radiology 1992; 183 (01) 167-170
• 37 Rossi SR, Falco AJ. Biliary stenting and other adjunctive therapies in the management of biliary obstruction. J Clin Gastroenterol 2019; 53 (03) 178-185
• 38 Gibson JL, Kuo MD. Brachytherapy for malignant biliary obstruction: techniques and outcomes. Semin Intervent Radiol 2017; 34 (02) 113-119
• 39 Rao S, Gupta S. The role of spyglass endoscopy in biliary interventions: a review. J Hepatobiliary Pancreat Sci 2016; 23 (06) 463-471
• 40 Chung DC, Alavi A. Photodynamic therapy for biliary tumors: current perspectives and future directions. J Gastrointest Oncol 2015; 6 (04) 406-413