Several decades ago, percutaneous transhepatic cholangiography (PTC) was developed to visualize the biliary obstruction and to provide access for fine needle aspiration. PTC is often used as a palliative procedure in patients with malignant obstructive jaundice. It has become the standard diagnostic and therapeutic method for biliary stenosis.
Cholangiography is a quick, painless procedure that allows the diagnosis of the severity of a biliary stricture. A dye solution is injected into the cystic duct. The dye travels around the stones and washes them out. When the dye has reached the gall bladder, the patient is aspirated. This makes it easier to separate the gall bladder from the liver bed.
A previous method for performing cholangiography required the introduction of a catheter into the cystic duct. This method was considered inconvenient because the catheter would be threaded through the cystic duct and there was no guarantee that the catheter would pass through the curved course of the duct. In addition, the external support of a flexible catheter with a hollow metal tube was found to be insufficient.
The aim of this study was to compare the diagnostic performance of percutaneous transhepatic cholangiography and endoscopic retrograde cholangiography (ERCP) for suspected malignant biliary strictures. A total of 79 patients were included in the study. Thirty-five patients were diagnosed with malignant biliary structure and twelve patients were diagnosed with positive histology/cytology. During the course of follow-up in group B, the final diagnosis was made. Moreover, adverse events were also recorded. The incidence of nasobiliary drainage, perforation of the extrahepatic bile duct and pancreatic duct manipulation were related to the adverse events.
The diagnostic performance of the methods was compared according to the following parameters: the positive predictive value (PPV), the negative predictive value (NPV), the percentage of positive results, and the percentage of negative results. In addition, the Fisher exact test was used to analyze the data. The PPV and NPV were found to be statistically significant. The NPV was higher than that of brush cytology. The percentage of positive results was higher than that of forceps biopsy.
PTC provided higher sensitivity than ERCP for the diagnosis of malignant biliary strictures. This method also had a positive effect on the diagnosis of strictures located at the hilum. However, it has a lower sensitivity than PTC for malignant biliary strictures located in the lower segment of the common biliary duct. This may be due to the long distance between the papilla of the Vater and the site of the stricture. However, the combination of brush cytology and forceps biopsy might increase the accuracy of the pathological diagnosis.
Cholangiography forceps are used in the surgical management of gall bladder disease. The bile leakage associated with cholangiography is similar to cystic ductotomy, but it is not caused by the incision. The forceps are placed into the abdominal cavity through a laparoscopic cannula and then secured to the catheter for intra-operative imaging. In addition, the Cholangiography Forceps offer sterility and no electro-planting surface treatment.
