Percutaneous transhepatic cholangiography: Difference between revisions

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'''Percutaneous transhepatic cholangiography''' ('''PTHC''' or '''PTC''') or '''percutaneous hepatic cholangiogram''' or '''Pre-Teen Hard Core''' is a radiologic technique used to visualize the [[anatomy]] of the [[biliary tract]]. A [[contrast medium]] is injected into a bile duct in the [[liver]], after which [[X-ray]]s are taken. It allows access to the biliary tree in cases where [[endoscopic retrograde cholangiopancreatography]] (ERCP) has been unsuccessful. Initially reported in 1937, the procedure became popular in 1952.<ref>{{cite journal |author=Carter RF, Saypol GM |title=Transabdominal cholangiography |journal=Journal of the American Medical Association |volume=148 |issue=4 |pages=253–5 |year=1952 |pmid=14888454 |doi=}}</ref><ref>{{cite journal |author=Atkinson M, Happey MG, Smiddy FG |title=Percutaneous transhepatic cholangiography |journal=Gut |volume=1 |issue= |pages=357–65 |year=1960 |pmid=13684978 |pmc=1413224 |doi=10.1136/gut.1.4.357}}</ref>

It is predominantly now performed as a therapeutic technique. There are less invasive means of imaging the biliary tree including transabdominal ultrasound, [[magnetic resonance cholangiopancreatography]], [[computed tomography]] and [[endoscopic ultrasound]]. If the biliary system is obstructed, PTC may be used to perform [[biliary drainage]] until a more permanent solution for the obstruction is performed (e.g. surgery). Additionally, self expanding metal stents can be placed across malignant biliary strictures to allow palliative drainage. Percutaneous placement of metal stents can be utilised when therapeutic ERCP has been unsuccessful, anatomy is altered precluding endoscopic access to the duodenum, or where there has been separation of the segmental biliary drainage of the liver, allowing more selective placement of metal stents. It is generally accepted that percutanous biliary procedures have higher complication rates than therapeutic ERCP. Complications encountered include infection, bleeding and bile leaks.