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CIRSE Standards of Practice on Percutaneous Transhepatic Cholangiography, Biliary Drainage and Stenting

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Abstract

This CIRSE Standards of Practice document is aimed at interventional radiologists and provides best practices for performing percutaneous transhepatic cholangiography, biliary drainage and stenting. It has been developed by an expert writing group established by the CIRSE Standards of Practice Committee.

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Abbreviations

CBD:

Common bile duct

CM:

Contrast media

CT:

Computed tomography

ERC:

Endoscopic retrograde cholangiography

MDCT:

Multidetector-row CT

MRCP:

Magnetic resonance cholangiopancreatography

MRI:

Magnetic resonance imaging

PTC:

Percutaneous transhepatic cholangiography

PTBD:

Percutaneous transhepatic biliary drainage

PTBB:

Percutaneous transhepatic biliary balloon dilation

PTBS:

Percutaneous transhepatic biliary stenting

US:

Ultrasound

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Funding

This study was not supported by any funding.

Author information

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, HELIOS Klinikum Duisburg, Duisburg, Germany

    Marco Das

  2. Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands

    Christiaan van der Leij & Babs M. F. Hendriks

  3. Department of Diagnostic and Interventional Radiology, HELIOS Klinikum Krefeld, Krefeld, Germany

    Marcus Katoh

  4. Department of Gastroenterology, HELIOS Klinikum Duisburg, Duisburg, Germany

    Daniel Benten

  5. Interventional Radiology Unit, Department of Radiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Adam Hatzidakis

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  1. Marco Das
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  5. Babs M. F. Hendriks
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Correspondence to Marco Das.

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Definitions

Percutaneous transhepatic cholangiography (PTC)

PTC is a diagnostic procedure for imaging of the biliary system. It is mainly performed when cross-sectional imaging is not sufficient for diagnosis. Contrast media (CM), usually iodinated CM, is injected into a bile duct after percutaneous puncture of a peripheral duct. Diagnostic images are obtained by fluoroscopy in one or more projections. As magnetic resonance cholangiopancreatography (MRCP), US and CT are widely available, diagnostic PTC has become rare. It is now mostly performed as the first step in percutaneous transhepatic biliary drainage.

Percutaneous transhepatic biliary drainage (PTBD)

PTBD is a therapeutic procedure to provide internal or external drainage of the obstructed biliary system. It involves percutaneous puncture of a (peripheral) biliary radicle, followed by fluoroscopic or US guided wire and catheter placement. Often an attempt is made to advance a guide wire into the duodenum (or into the jejunum in surgically altered anatomy), in order to place an external-internal drain. PTBD can involve a right sided or a left sided approach or a combination of both, depending on best access route and underlying pathology.

Percutaneous biliary balloon dilatation (PBBD)

PBBD is a therapeutic procedure for the treatment of biliary strictures using intra ductal balloon dilatation. After percutaneous puncture, the stricture is passed with a guidewire. A balloon is inflated (usually for several minutes) to eliminate or improve the stricture. One PBBD session may require several balloon inflations. Usually a drainage catheter is placed after balloon dilatation at or just above the former stricture site.

Percutaneous transhepatic biliary stenting (PTBS)

This therapeutic procedure is used for temporary or permanent stenting of a biliary stricture in order to restore internal bile drainage. After percutaneous puncture, the stricture is passed with a guidewire. A plastic or metal (un)covered stent is then placed at the site of the stricture.

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Das, M., van der Leij, C., Katoh, M. et al. CIRSE Standards of Practice on Percutaneous Transhepatic Cholangiography, Biliary Drainage and Stenting. Cardiovasc Intervent Radiol 44, 1499–1509 (2021). https://doi.org/10.1007/s00270-021-02903-4

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