Endoscopic retrograde and percutaneous transhepatic cholangiography

Abstract

The direct visualisation of the bile duct with a retrograde (endoscopic) or antegrade (transhepatic) approach has become a successful means for investigating biliary tract disease for more than 30 years. Percutaneous transhepatic cholangiography (PTC) was first reported in the literature in 1937 but did not become popular until the 1950s after it gained attention in the English-speaking literature [6]. Endoscopic retrograde cholangiography (ERC) was first reported in 1968 and spread throughout Europe and Japan to the United States in the early-mid-1970s after improved instruments were developed and the feasibility of therapeutic applications made it more attractive (initially biliary sphincterotomy and biliary stenting) [9] Today, both methods allow for a variety of diagnostic and therapeutic maneuvers, though ERC is preferred over PTC as a first-line procedure as it is less invasive and generally has a lower risk of complications [38]. Indeed, ERC has become an indispensable tool in the practice of modern gastroenterology. Despite providing revolutionary methods for investigating disorders and diseases of the biliary system, PTC and ERC are becoming less commonly used for purely diagnostic purposes, as this role has been taken over by less invasive imaging modalities, such as magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS). Therefore, in the vast majority of cases, ERC is performed with the intention of performing a therapeutic intervention such as bile duct stone removal, biopsy/brushing of a stricture or mass, biliary stenting, and more. This chapter is meant as a general overview of the use of cholangiography (mainly ERC) in the diagnosis and management of patients with hepatobiliary disorders. Pancreatography and exclusively pancreatic disorders will therefore not be discussed, and we refer the interested reader to specialized textbooks for this purpose. As one reads this overview, it is important to recognize that, due to the relative paucity of high-quality prospective controlled studies in the field of ERC, much of its clinical practice has been based mainly on expert opinion and experience. © Springer-Verlag Berlin Heidelberg 2010.