Abstract No. 14 Efficacy of Percutaneous Transhepatic Cholangioscopy in Managing Bilio-enteric Complications in Patients with Prior Surgery

The purpose of this study was to evaluate the efficacy of Percutaneous Transhepatic Cholangioscopy (PTCS) in managing bilioenteric complications in patients with surgically altered anatomy of the hepatobiliary system. We conducted a retrospective review of patients from the Cholangioscopy registry with prior surgical history and presented with bilioenteric complications. Indications, procedure details, procedure and fluoroscopy duration, technical and clinical success rates, and complications were assessed. A total of 46 patients (mean age, 57.4 ± 19.56 years; 25 males, 21 females) underwent 84 PTCS procedures. Among these, 18 patients had a prior liver transplant, 12 underwent prior pancreaticoduodenectomy, 8 had cholecystectomy with hepaticojejunostomy, 6 underwent choledochojejunostomy, and 2 patients had hepatic resection with hepaticojejunostomy. The indications for PTCS included intra and/or extrahepatic stones in 26 (56.6%) patients, anastomotic stricture in 8 (17.4%), and biliary stone-associated strictures in 12 (26%) patients. The median number of PTCS procedures performed per patient was 2 (range 1 to 8). PTCS was performed through the right and left biliary system in 56 (66.67%) and 28 (33.33%) procedures, respectively. Reusable scopes were used in 76 (90.5%) procedures and disposable scopes in 8 (9.5%). Additional therapeutic devices were used in 43 procedures including Holmium YAG lithotripsy in 22 procedures, balloon dilatation in 6, electrohydraulic lithotripsy in 2, retrieval balloons in 3, and a combination of these in 10 procedures. The median procedure and fluoroscopy durations were 61 and 4.9 minutes, respectively. Technical success was achieved in 44 (95.6%) patients, with failures in one patient with hepatolithiasis and one patient with biliary stricture. Clinical success was attained in 37 (80.5%) patients; failures were noted in 2 patients with cholelithiasis/choledocholithiasis, 4 with strictures, and 3 patients with both calculi and strictures. Only three adverse events (3.5%) were reported, two patients experienced transient chills and fever which required no intervention. The third event involved brief extrabiliary extension of the cholangioscope complicated by a small perihepatic collection, which subsequently resolved with percutaneous drainage. PTCS was demonstrated to be a safe and effective therapeutic modality in the treatment of biliary complications in patients with surgically altered anatomy. However, long-term follow up is necessary to evaluate for disease recurrence.