Document Detail


Experience with percutaneous transhepatic cholangioscopy (PTCS) in the management of biliary tract disease.
MedLine Citation:
PMID:  10594265     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Biliary tract disorders often present significant management difficulties, particularly in patients who are poor surgical candidates. Percutaneous transhepatic cholangioscopy (PTCS) is an infrequently utilized alternative that might offer significant therapeutic benefit. We reviewed our experience with the use of this modality as a definitive therapy for biliary tract disorders. METHODS: Patient records at the Atlanta VAMC and Emory University hospitals were reviewed. We identified 17 patients who had undergone 25 PTCS interventions between August 1994 and December 1998. The indications for PTCS included dilatation of biliary-enteric anastomoses in four patients, biliary stone removal (with or without lithotripsy) in eight patients, stricturoplasty in four patients, biopsy of suspected biliary neoplasms in seven patients, and removal of obstructing clot in one patient. Most procedures (n = 17) were performed through percutaneous transhepatic tracts (12-18 Fr) that were <1 week old. All tracts were dilated to operating size on the day of the procedure. All patients received periprocedural antibiotics. RESULTS: The interventions were successful in seven of eight stone removals, four of five stricturoplasties, three of four anastomotic dilatations, seven of seven biopsies, and the single clot removal. The only complication involved one episode of hemobilia, requiring angio-embolization of a small branch of the right hepatic artery. CONCLUSIONS: PTCS is a safe, useful, and well-tolerated adjunct to the more common endoscopic and surgical techniques for managing complicated biliary tract disorders. Our experience suggests that PTCS can be performed early, without prolonged sequential dilatation of the percutaneous transhepatic tract, and may allow avoidance of operation in high-risk surgical candidates.
Authors:
T Simon; A S Fink; A M Zuckerman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgical endoscopy     Volume:  13     ISSN:  0930-2794     ISO Abbreviation:  Surg Endosc     Publication Date:  1999 Dec 
Date Detail:
Created Date:  2000-02-04     Completed Date:  2000-02-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  GERMANY    
Other Details:
Languages:  eng     Pagination:  1199-202     Citation Subset:  IM    
Affiliation:
Department of Surgery, Emory University School of Medicine and Atlanta Veterans Administration Hospital, Atlanta, GA 30033, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Biliary Tract Diseases / therapy*
Biopsy
Endoscopy, Digestive System* / adverse effects
Humans
Middle Aged
Retrospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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