from PART III - ORGAN-SPECIFIC CANCERS
Published online by Cambridge University Press: 18 May 2010
In the early 1970s, Molnar and Stockum introduced nonsurgical biliary intervention in the form of percutaneous transhepatic biliary drainage (PTBD) (1). Percutaneous transhepatic cholangiography (PTC) had been performed for several years prior to this, but therapeutic biliary interventions had been outside the radiologists' domain. In the past 30 years, improved diagnostic imaging techniques and significant developments in interventional radiology and experience gained by clinical trials have revolutionized and clearly defined the role of percutaneous biliary interventions.
The role of PTC has progressively diminished in the face of noninvasive imaging techniques such as ultrasonography (US), three-dimensional (3D) computer tomography and magnetic resonance cholangiography (MRC). Endoscopic retrograde cholangiography has further reduced its diagnostic role in the recent years. PTC is now reserved only for problematic cases and as an evaluation immediately prior to percutaneous intervention.
PTBD, which was initially proposed as a routine preoperative measure for those with severe obstructive jaundice, is now more of a palliative procedure in patients with inoperable malignant obstruction. This has been brought about by improved preoperative patient preparation, good antibiotic therapy, improved surgical techniques and easy availability of endoscopic biliary drainage expertise. One of the most important recent advances has been the introduction of self-expanding metallic stents for use in malignant obstructions.
In this chapter, we discuss all of the aforementioned percutaneous interventional radiological techniques, their indications and the other issues involved.
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