A Case Series of Patients with Altered Gut Anatomy Treated for Biliary Disease with Percutaneous Transhepatic Cholangioscopy with Lithotripsy

Abstract Background and Aims: Treating obstructive bile duct pathologies in individuals with altered bowel anatomy is challenging, since the physiological context may render endoscopic retrograde cholangiopancreatography (ERCP) difficult or unfeasible. Percutaneous transhepatic cholangiography (PTC) with drain placement can provide adequate drainage in this patient group, but it has limited therapeutic options. Methods: In this case series, we present 14 patients with altered bowel anatomy who underwent PTC drain placement followed by percutaneous cholangioscopy (PC) between January 2015 and May 2022 at a single institution. Results: Of the 14 patients, most common indication for PTC was choledocholithiasis in 13 (92.9%) patients and 8 (57.1%) of these patients exhibited cholangitis on initial presentation. The mean age was 66.4 years, and most were female (64.3%). All patients had altered anatomy, with Roux-en-Y gastric bypass being the most common (71.4%). There were 3 patients who had previous unsuccessful attempts at ERCP. Pre-procedural laboratory tests indicated elevated mean liver enzyme levels, and all cases of choledocholithiasis were successfully treated (92.9%). No complications were reported in any patients after a mean follow-up period of more than 2 years. Conclusions Cholangioscopy and lithotripsy via the PTC route may be a viable therapeutic option, with a high success rate and low risks, when ERCP is challenging or impossible due to patient’s altered gut anatomy.