What are the indications and contraindications for use of percutaneous transhepatic cholangiography (PTC) in the management of gallstones (cholelithiasis)?

Updated: Apr 01, 2019
  • Author: Douglas M Heuman, MD, FACP, FACG, AGAF; Chief Editor: BS Anand, MD  more...
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Percutaneous transhepatic cholangiography (PTC) may be the modality of choice in patients in whom ERCP is difficult (eg, those with previous gastric surgery or distal obstructing CBD stone), in the absence of an experienced endoscopist, and in patients with extensive intrahepatic stone disease and cholangiohepatitis. A long large-bore needle is advanced percutaneously and transhepatically into an intrahepatic duct, and cholangiography is performed. A catheter can be placed in the biliary tree over a guidewire.

Uncorrected coagulopathy is a contraindication for PTC, and the normal size of the intrahepatic ducts makes the procedure difficult. Prophylactic antibiotics are recommended to reduce the risk of cholangitis.

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